Clinical History.—A 6-year-old boy was riding his bike and struck a bridge abutment. He was hospitalized for severe head trauma, requiring endotracheal intubation and assisted ventilation. After seven days, a tracheostomy was performed. He recovered from head injuries and after six weeks, the tracheostomy was decannulated, at which time granulation tissue around the tracheostomy site was excised. The tracheostomy wound healed uneventfully. Five weeks after decannulation, hoarseness and mild inspiratory stridor developed. A lateral roentgenogram of the neck (Figure) was obtained.
Denouement and Discussion
Tracheal Granuloma at Tracheostomy Site
Tracheostomy-related complications are increasing concomitant with more frequent tracheostomy and cuffed tracheostomy tubes with mechanically assisted ventilation. Late complications include granuloma formation, tracheal stenosis, and/or tracheomalacia, occurring at the site of incision or at the site of the balloon cuff.1The combined incidence of stenosis and granuloma after tracheostomy ranges from 1.5% to 10%2,3 but is somewhat lower, 2% to 3%,
Young LW, Bowen A, Oh KS. Radiological Case of the Month. Am J Dis Child. 1978;132(7):713-714. doi:10.1001/archpedi.1978.02120320073016