Abstract
Obstructive sleep apnea syndrome (OSAS) often poses challenges to anesthesiologists. Gomez-Merino reported a case of T-cell lymphoma that began with symptoms of OSAS.
We encountered a case of solitary extranodal lymphoma in the palatine tonsils masked by SAS, which consequently caused unanticipated difficulty in intubation during surgery for SAS, i.e., palatine tonsillectomy.
A 51-year-old male presented to a local ENT doctor with continuing discomfort in the throat after upper respiratory tract infection is reported. He also had difficulty in swallowing solid food. It was suspected that the patient had OSAS, and he was referred to our clinic.
The patient showed markedly hypertrophic bilateral palatine tonsils (Mackenzie's grade III) and notable lingual tonsil swelling. ENT fiberscope only showed the posterior margin of the vocal cords and the arytenoids region. Because no other abnormalities were noted, uvulopalatinopharyngoplasty (UPPP) under general anesthesia was planned. During the operation, full attempt was made to visualize the airway, which revealed papillary neoplastic proliferation extending from the tongue base to the larynx, with the epiglottis atrophied and the trachea and vocal cords indistinguishable. It was difficult to perform endoscopic intubation, and a tracheostomy was required. Subsequent biopsy of the tonsils showed no further abnormality, and the UPPP was performed on a later date. The patient was histopathologically diagnosed with peripheral T-cell lymphoma, unspecified.
Because mediastinal emphysema with aspiration pneumonia and cervical esophageal minimal perforation developed as complications, elective operation was canceled and the patient was kept in ICU for two weeks, during which time drainage tubes were inserted at the superior mediastinum for two weeks.
We discuss a rare case of intubation difficulty due to T-cell lymphoma that presented as OSAS, with consideration of relevant literature.
