Obstructive fibrinous tracheal pseudomembrane: Sudden child death following laser removal of papillomata

Abstract

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare complication usually following endotracheal intubation, occurring when a collection of inflammatory exudate coalesces at the site of damaged epithelium within the trachea and along the tracheal mucosa, creating a luminal narrowing and subsequent airway obstruction.

Keywords: inflammatory pseudomembrane; laryngeal papillomatosis; obstructive fibrinous tracheal pseudomembrane; sudden death; upper airway obstruction.

FIGURE 1

This figure depicts the larynx and trachea at autopsy, with the surgical bed visible in the glottis and subglottic region, and the extensive inflammatory pseudomembrane visible in the proximal trachea, ±30 mm below the true vocal cords. This pseudomembrane measured ±25 mm in length

FIGURE 2

This figure shows a cross section of the proximal trachea, including the inflammatory pseudomembrane, after it had been fixed in formalin. The inflammatory pseudomembrane extends circumferentially around the mucosa of the trachea, almost completely occluding the lumen of the trachea

FIGURE 3

This figure exhibits a histological section of the trachea and inflammatory pseudomembrane. Tracheitis was clearly present, with a partially adherent inflammatory exudate. Abundant granulation tissue was forming, and neovascularization was further observed in the affected region

FIGURE 4

These histological sections depict the inflammatory pseudomembrane, which greatly decreased the aperture of the lumen of the trachea. The pseudomembrane consisted of a dense, acute inflammatory exudate, including abundant neutrophils, red blood cells, entrapped mucous, as well as fibrin layering

FIGURE 5

H&E histological staining clearly showing fibrin layering within the inflammatory pseudomembrane