When percutaneous dilation tracheotomy may be hazardous: abnormal course of the brachiocephalic trunk.

INTRODUCTION: Percutaneous dilatational tracheotomy (PDT) is becoming increasingly popular in present day critical care medicine. In contrast to the surgical approach, PDT involves a blind puncture and dilation of the pretracheal space, which may predispose to dangerous complications in the case of anatomical, in particular vascular, anomalies. METHODS AND
RESULTS: We report on two patients, in whom an abnormal pulsation was detected when the infracricoid region was palpated in preparation for PDT. An immediately performed ultrasound scan revealed an arterial blood vessel in front of the upper part of the trachea. A subsequent CT-angiography showed an anomalous course of the brachiocephalic trunk. While too dangerous for PDT, the local department of cranio-maxillofacial surgery was consulted for surgical tracheotomy.
CONCLUSION: To avoid hazardous bleeding complications in PDT we recommend at least an ultrasound scan in case of an abnormal pulsation and an enlarged thyroid gland.