Correspondence

Case 46-1992: Correction

N Engl J Med 1993; 328:1642-1643June 3, 1993

Article

To the Editor:

I should like to call attention to an error in Case 46-1992 (Nov. 19 issue)1. The patient, a middle-aged woman with severe tracheal distortion, was described as having undergone placement of “a 6-French pediatric cuffed endotracheal tube” before coronary-artery bypass surgery. This is extremely unlikely, since a 6-French endotracheal tube has an external diameter of less than 2 mm and is not commercially available. Its small internal diameter (less than 1.5 mm) would have greatly increased resistance to airflow; perioperative ventilation and oxygenation would have been almost impossible2. It is more likely that a 6.0 endotracheal tube (internal diameter, 6.0 mm) was placed. The patient's inability to accommodate a larger endotracheal tube (internal diameter, 7.0 mm) was unusual and suggested that the anatomy of her airway was abnormal.

Paul Lennon, M.D.
National Naval Medical Center, Bethesda, MD 20889

2 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 46-1992). N Engl J Med 1992;327:1512-1518
   Full Text | Web of Science | Medline

2. 2

   Dallen LT, Wine R, Benumof JL. Spontaneous ventilation via transtracheal large-bore intravenous catheters is possible. Anesthesiology 1991;75:531-533
   CrossRef | Web of Science | Medline

To the Editor:

The anatomical diagnosis in Case 46-1992 -- “Tracheopathia osteoplastica. (Saber-sheath trachea.)” -- is misleading if taken at face value. The unfortunate parenthetical juxtaposition wrongly implies an association, equivalence, or identity between saber-sheath trachea and tracheopathia osteoplastica, when in fact none exists. As noted by the discusser, a saber-sheath trachea is a deformity confined to the intrathoracic portion of the trachea1. In the patient described in Case 46 both the cervical and thoracic portions of the trachea were deformed by tracheopathia osteoplastica. The saber-sheath deformity, in contrast, is confined to the intrathoracic trachea and is closely associated with clinical signs of chronic airways disease, especially chronic bronchitis2. It is thought to develop from coughing-induced chronic degeneration and softening of tracheal cartilage, with subsequent abnormal reformation due to intrathoracic forces. There is no “saber-sheath trachea” in this case, but an unrelated deformity of the cervical and intrathoracic trachea due to tracheopathia osteoplastica.

Reginald Greene, M.D.
Massachusetts General Hospital, Boston, MA 02114

2 References

1. 1

   Greene R, Lechner GL. “Saber-sheath” trachea: a clinical and functional study of marked coronal narrowing of the intrathoracic trachea. Radiology 1975;115:265-268
   Web of Science | Medline

2. 2

   Greene R. “Saber-sheath” trachea: relation to chronic obstructive pulmonary disease. AJR Am J Roentgenol 1978;130:441-445
   Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Dr. Lennon is probably correct in his observation. The patient had undergone coronary bypass surgery at another institution. The size of the cuffed endotracheal tube was transcribed from the referred operative report, without correction.

The diagnoses of tracheopathia osteoplastica and saber-sheath trachea were meant to be separate. There was no intention to equate the two. The general use of parentheses in the anatomical diagnosis is to indicate that such a diagnosis may be present but that there is no anatomical proof of it. The diagnosis of saber-sheath trachea was based on the endoscopic appearance of a saber-sheath-like deformity observed at endoscopy, and was placed in parentheses because the deformity was not present in the resected specimen. We agree with Dr. Greene that “saber-sheath-like deformity” would have been more correct than “saber-sheath trachea.”

Eugene J. Mark, M.D.
Hermes C. Grillo, M.D.
Massachusetts General Hospital, Boston, MA 02114

Citing Articles (1)

Citing Articles

1. 1

   Mindy B. Tinkle, Bobbie Sue Sterling. (1997) Neural Tube Defects: A Primary Prevention Role for Nurses. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 26:5, 503-512
   CrossRef