Subglottic stenosis following repeated double-lumen tube intubation for whole-lung lavage in a teenager with pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis is a rare disorder with decreased clearance of surfactant from the pulmonary alveoli resulting in progressive respiratory distress. Whole-lung lavage remains an important procedure for symptomatic relief in patients with pulmonary alveolar proteinosis. If a double-lumen tube can be placed, lavage of one side of the lung is performed through one lumen while the patient is ventilated through the other lumen. We present a patient with pulmonary alveolar proteinosis who, starting at age ten years, underwent multiple intubations with double lumen tubes for alveolar lavage and developed subglottic stenosis which we believe may have been related to the repeated attempts to insert as large as possible a double lumen tube to facilitate lavage. The subglottic stenosis was relieved lastingly following surgical intervention. Subsequently, the smallest double lumen tube which would still appear to be appropriately sized by bronchoscopy and would allow alveolar lavage without spillage was chosen, and dexamethasone was routinely administered around the time of double lumen tube insertion.