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A 3-month-old male infant presented with intermittent low-grade
fever from the age of 1 month. On investigation, a nonhomogenous
opacity was found in the upper lobe of the right lung. A computerized
tomographic scan revealed loss of aeration of the right upper lobe and
partial collapse of the middle lobe. A provisional diagnosis of
congenital cystic adenomatoid malformation of the lung (with
episodes of infection) was made. We describe the use of a single lumen
tracheal tube (TT) for thoracotomy and lobectomy in this infant. The
surgical procedure was complicated by a flood of thick, semisolid
caseous material from the TT tube causing hypoxia and inability to
ventilate the infant. The problem was managed appropriately in the
circumstances. The infant died on the 10th postoperative day after two
episodes of pneumothorax and, finally, sepsis, and multiorgan failure.
Histopathological examination of the tissues and smears revealed
acid-fast bacilli in all fields and confirmed the diagnosis of perinatal
tuberculosis. This appears to be the first report of its kind of an
anesthetic complication of perinatal tuberculosis. A brief update on
this condition and the importance of lung separation in infants
undergoing thoracotomy is discussed.