Vertebral erosion: a rare complication of tracheostomy tube

Excerpt

A 20-year-old male with tetraplegia, permanent tracheostomy and prolonged mechanical ventilation was referred to our unit with episodes of mechanical ventilator dyssynchrony. The patient’s medical history also included hyper-IgM syndrome, generalized dystonia and tracheomalacia that was managed with placement of an adjustable-length tracheostomy tube. A thoracic computed tomography scan showed tracheal distension around the tube cuff and T1–T4 vertebral body circumscribed anterior erosions (Fig. 1a–c). During the 5 months prior to his referral to our hospital, he had been admitted to another institution with the diagnosis of possible osteomyelitis at the same vertebral levels. At that time thoracic magnetic resonance imaging had revealed similar findings (Fig. 1d). We hypothesized that the triggering factor for the development of bone resorption and possibly osteomyelitis at that level was the cuff overdistension which compromised blood perfusion to the vertebral bodies. In fact, during his hospitalization in our unit, cuff pressures were kept high to achieve adequate tracheal sealing. Oesophageal endoscopy revealed no tracheoesophageal fistula, a more expected complication of cuff overdistension. Vertebral erosion, in cases of cuff overdistension and tracheomalacia, is a rare complication of tracheostomy tube, but its early radiographic recognition may prevent further serious sequelae.

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