STEAM INHALATION CAUSING DELAYED AIRWAY OCCLUSION

A 40-year-old man was working in an enclosed space at a nuclear power plant when a high-temperature, high-pressure steam pipe ruptured, burn ing 60% of his body. Sudden hoarseness prompted endotracheal intubatio n, and edematous vocal cords were seen. The initial chest radiograph w as normal (Fig. 1A). Normal gas exchange was maintained, and the patie nt was extubated on the second hospital day. Subsequent chest radiogra phs showed bibasilar atelectasis and mild perihilar pulmonary edema. T he patient responded well to treatment for his burns but on the sevent h day abruptly became dyspneic, hypoxic, and hypotensive. Cardiopulmon ary arrest followed, and the patient died despite resuscitative effort s. Autopsy showed a severe necrotizing laryngotracheobronchitis (Fig. 1B). The airway mucosa from the hypopharynx and larynx to the trachea and large bronchi was markedly hyperemic and edematous, with a loose, friable yellow-gray pseudomembrane. The lungs were edematous, but no o ther cardiopulmonary abnormalities were present. Death was attributed to acute airway occlusion by the sloughed pseudomembrane.