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Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 335:1303-1307 October 24, 1996 Number 17
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Case 33-1996— A 55-Year-Old Man with a Long-Term Tracheostomy and Acid-Fast Bacilli in Peristomal Granulations
Dori F. Zaleznik, and Timothy R. Quinn

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Presentation of Case

A 55-year-old man with obstructive sleep apnea, which had been managed by a long-term tracheostomy, was admitted to the hospital because acid-fast bacilli were found in stomal granulations.

Eighteen and a half years earlier, obstructive sleep apnea, with an arterial oxygen saturation of 44 percent, was diagnosed. Examination revealed a mandibular deformity and a large, hypermotile tongue with abundant lymphoid tissue at its base. Four years later, a tracheostomy was performed at the Massachusetts Eye and Ear Infirmary, with the placement of a silicone cannula. The cannula was changed every two to three years. At approximately semiannual visits, the patient . . . [Full Text of this Article]

Differential Diagnosis

Clinical Diagnosis

Dr. Dori F. Zaleznik's Diagnosis

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