Lisa K. Brath

Tracheal ring herniation.

Inspection bronchoscopy during percutaneous dilational tracheostomy has become the standard of care to reduce complications of the procedure. During bronchoscopy, anatomic defects can be visualized before performing the procedure. We describe a case of discovering herniated tracheal rings in preprocedure bronchoscopy and subsequent treatment of this rare finding.

A 47-Year-Old Woman With Progressive Dyspnea and Recurrent Pneumothoraces

47-year-old woman was referred for evaluation of dyspnea and recurrent bilateral pneumothoraces, with the last episode requiring left apical resection and talc pleurodesis. The pathology from this procedure revealed only a scarred bleb lining. Dyspnea was described as insidious and gradually progressive since onset 5 years earlier. The medical history was notable for emphysema. The findings of a review of systems was otherwise negative, as was the family history. A social history revealed a 10 pack-year history of smoking with current use being described as sporadic. The physical examination findings were unremarkable with the exceptions of pulse oximetry values of 82% while breathing room air and a well-healed thoracotomy scar. The data available at the time of referral included normal serum chemistry levels, CBC, and 1-antitrypsin levels, along with pulmonary function test (PFT) results that revealed an FEV1 74% of predicted, FVC 97% of predicted, and FEV1/FVC ratio 62% of predicted. The diffusing capacity of the lung for carbon monoxide (Dlco) was also 27% of predicted.