Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure and an Incidental Finding of Tracheobronchomalacia: A Case Report

於慢性阻塞性肺疾病併發急性呼吸衰竭病人意外發現支氣管軟化症：一個病例報告

邱立忠(Li-Chung Chiu) ； 蘇奕豪(I-Hao Su) ； 高國晉(Kuo-Chin Kao) ； 劉劍英(Chien-Ying Liu) ； 楊政達(Cheng-Ta Yang) ； 黃建達(Chien-Da Huang)

《胸腔醫學》 27卷6期 (2012/12) Pp. 349-356

https://doi.org/10.29806/TM.201212.0004

摘要

支氣管軟化症是支氣管在吐氣時管腔狹窄超過50%且可能造成呼吸衰竭。先天或後天因素都可能造成支氣管軟化症。後天因素造成支氣管軟化症和氣管內管、氣切、封閉式胸部外傷、肺切除、廣泛性頸部切除手術、放射治療、慢性阻塞性肺疾病、再發性多處軟骨炎、氣管旁血管異常和慢性或反覆性感染有關。我們報告一位50歲慢性阻塞性肺疾病男性患者因支氣管軟化症併發高二氧化碳呼吸衰竭。肺功能，氣管鏡和4D動態容量肺部電腦斷層診斷為支氣管軟化症。本篇案例報告使我們更加了解吐氣時呼吸道塌陷對慢性阻塞性肺疾病造成之影響。當慢性阻塞性肺疾病患者併發急性呼吸衰竭時，臨床醫師需考慮支氣管軟化症之可能性。

關鍵字

支氣管軟化症 ； 慢性阻塞性肺疾病 ； 急性呼吸衰竭 ； 4D動態容量肺部電腦斷層

並列摘要

Tracheobronchomalacia (TBM), characterized by more than 50% expiratory reduction of the cross-sectional area of the trachea and bronchus, may cause respiratory failure. Its etiology may be congenital or acquired. Acquired TBM is reportedly associated with endotracheal tubes and tracheostomy, closed chest trauma, lung resection, radical neck dissection, radiation therapy, chronic obstructive pulmonary disease (COPD), relapsing polychondritis, paratracheal vascular abnormality, and chronic or recurrent infection. Herein, we report a 50-year-old male COPD patient with TBM resulting in hypercapnic respiratory failure. Flow-volume loop, bronchoscopy and 4-dimensional dynamic volume computed tomography (4D CT) of the lung confirmed the diagnosis of TBM. This case report broadens the understanding of the contribution of expiratory central airway collapse to COPD morbidity. Clinicians should be alert to the possibility of TBM when acute respiratory failure is noted in COPD patients.

並列關鍵字

tracheobronchomalacia ； chronic obstructive pulmonary disease ； acute respiratory failure ； four-dimensional dynamic volume computed tomography