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LETTER TO EDITOR
Year : 2017  |  Volume : 34  |  Issue : 1  |  Page : 108  

Amphoric abdomen: An unusual finding


Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication30-Dec-2016

Correspondence Address:
Inderpaul Singh Sehgal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.197112

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How to cite this article:
Baldi M, Sehgal IS, Dhooria S, Agarwal R. Amphoric abdomen: An unusual finding. Lung India 2017;34:108

How to cite this URL:
Baldi M, Sehgal IS, Dhooria S, Agarwal R. Amphoric abdomen: An unusual finding. Lung India [serial online] 2017 [cited 2019 Jul 24];34:108. Available from: http://www.lungindia.com/text.asp?2017/34/1/108/197112



Sir,

A 62-year-old male, a known case of squamous cell carcinoma of esophagus (status postchemoradiotherapy), presented to the emergency department with history of cough with copious expectoration of 15-day duration and worsening breathlessness of 5-day duration. Examination revealed diffuse crackles over bilateral lung fields. The patient was intubated and mechanically ventilated for respiratory failure. Few hours after intubation, there was gradual distension of the abdomen, and auscultation over the left hypochondrium revealed amphoric sounds. Esophageal intubation was ruled out by laryngoscopic examination and capnometry; a possibility of bronchoesophageal fistula was considered. Pre- and post-intubation radiographs were reviewed that revealed gaseous distension of the abdomen postintubation [Figure 1]. Flexible bronchoscopy at bedside revealed a fistulous communication between the left main bronchus and the esophagus. A metallic Y-stent insertion was planned; however, the patient succumbed to his illness within few hours of presentation to the intensive care unit.
Figure 1: Left panel: Chest radiograph (preintubation) revealing nonhomogeneous opacification in bilateral lower zone (right>>left) suggestive of aspiration pneumonia; Right panel: Supine radiograph of the abdomen revealing gaseous distension of the stomach and the small and large bowel

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Amphoric type of bronchial breath sounds has been classically described in the presence of a superficial large cavity that has smooth walls and a communicating patent bronchus. It can also be appreciated in an open pneumothorax.[1] However, amphoric type of 'breath' sound over the abdomen has not been described previously. In the index case, the setting was perfect for producing an amphoric breath sound during positive airway pressure ventilation where a superficial cavity with smooth walls (stomach) was communicating with a patent airway (fistula).

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   References Top

1.
Sarkar M, Madabhavi I, Niranjan N, Dogra M. Auscultation of the respiratory system. Ann Thorac Med 2015;10:158-68.  Back to cited text no. 1
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