BMJ case reports
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Case Reports
Intubating laryngeal mask airway combined to fibreoptic intubation in subglottic stenosis.
We reported a successful airway management in a patient with unknown tracheal stenosis admitted in the emergency room for benzodiazepine overdose. The use of intubating laryngeal mask airway in combination with fibreoptic intubation was easy and safe in this patient; procedures such as ventilatory control and patient oxygenation were continued during intubation attempts, lessening the likelihood of desaturation. This method allowed the diagnosis of tracheal stenosis and soft endotracheal intubation.
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We present two uncommon underlying causes of a sore throat which, if missed or delayed in diagnosis, can lead to disastrous consequences. Our first case is of Lemierre's syndrome diagnosed in a 21-year-old man presenting with a 5-day history of sore throat, fever, right-sided pleuritic chest pain and bilateral pulmonary nodules on CT imaging. Fusobacterium necrophorum cultured from peripheral blood and an occluded left internal jugular vein on ultrasound lead to an eventual diagnosis. ⋯ A left-sided quinsy was diagnosed and aspirated and the patient was discharged home. She represented shortly with worsening pleuritic pain and was found to have a right-sided pleural effusion with descending mediastinitis originating from the tonsillar abscess. Delayed diagnosis resulted in open thoracotomy, decortication and prolonged intravenous antibiotics.