Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 2005-6184 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2009.67.2.140 Case Report A Case of Tracheal Carcinoma Diagnosed by Rigid Bronchoscopy in Lidocaine Anaphylaxis Patient Yoon Byeong Kab M.D. 1 Ban Hee Jung M.D. 1 Kwon Yong Soo M.D. 1 Oh In Jae M.D. 1 Kim Kyu Sik M.D. 1 Kim Yu Il M.D. 1 Lim Sung Chul M.D. 1 Kim Young Chul M.D. 1 Song Sang Yoon M.D. 2 Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. Department of Thoracic & Cardiovascular Surgery, Chonnam National University Medical School, Gwangju, Korea. Address for correspondence: Kyu Sik Kim, M.D. Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeonnam 519-809, Korea. Phone: 82-61-379-7615, Fax: 82-61-379-7628, cyberkks@chonnam.ac.kr 08 2009 31 08 2009 67 2 140 144 15 07 2009 06 08 2009 Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved. 2009

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.

 Lidocaine anaphylaxis Rigid bronchoscopy Flexible bronchoscopy Ikeda S Yanai N Ishikawa S Flexible bronchofiberscope Keio J Med 1968 17 1 16 Gall H Kaufmann R Kalveram CM Adverse reactions to local anesthetics: analysis of 197 cases J Allergy Clin Immunol 1996 97 933 937 Fulkerson WJ Current concepts: fiberoptic bronchoscopy N Engl J Med 1984 311 511 515 Credle WF Jr Smiddy JF Elliott RC Complications of fiberoptic bronchoscopy Am Rev Respir Dis 1974 109 67 72 Sim SJ Han JD Ryu WS Lee DW La DJ Park CW Anaphylactic reaction after topical lidocaine anesthesia during bronchoscopy J Asthma Allergy Clin Immunol 1999 19 219 223 Ruffles SP Gayres JG Fatal bronchospasm after topical lignocaine before bronchoscopy Br Med J (Clin Res Ed) 1987 294 1658 1659 Prakash U Mason RJ Courtney Broaddus V Murray JF Nadel JA Chapter 22. Bronchoscopy Murray and Nadel's textbook of respiratory medicine 2005 4th ed Pennsylvania Elsevier Saunders 617 650 Niwa H Tanahashi M Kondo T Ohsaki Y Okada Y Sato S Bronchoscopy in Japan: a survey by the Japan Society for Respiratory Endoscopy in 2006 Respirology 2009 14 282 289 Pue CA Pacht ER Complications of fiberoptic bronchoscopy at a university hospital Chest 1995 107 430 432 British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee of Standards of Care Committee of British Thoracic Society British Thoracic Society guidelines on diagnostic flexible bronchoscopy Thorax 2001 56 Suppl 1 i1 i21 Wu FL Razzaghi A Souney PF Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia Pharmacotherapy 1993 13 72 78 Lee SM Song WJ Yang MS Lee SH Kwon JW Kim TW A case of lidocaine anaphylaxis J Asthma Allergy Clin Immunol 2006 26 249 253 In JH Choi JW Joo J Kim DW Jung H Park H Intraoperative anaphylaxis after local infiltration of lidocaine for dental treatment under general anesthesia: a case report Korean J Anesthesiol 2008 55 395 398 Birnbaum J Porri F Pradal M Charpin D Vervloet D Allergy during anaesthesia Clin Exp Allergy 1994 24 915 921

Chest X-ray shows a lower tracheal stenosis (arrow) by circumferential mass.

Chest computed tomography shows a tracheal stenosis by irregular hypertrophy of lower endotracheal wall.

(A) Bronchoscopic finding shows a tracheal stenosis by irregular endotracheal mass in lower trachea. (B) This shows Karl Storz endoskope set. (C) This bronchoscopic finding shows that rigid bronchoscopy was performed to reestablish patency of the airway by means of mechanical removal. An arrowhead shows a tip of rigid bronchoscope. (D) Normal orifices of both main bronchi are seen.