Toracele

Toracele is a rare and often fatal condition characterized by the sudden and severe swelling of the neck, typically occurring in the throat (laryngeal edema) or the chest (tracheobronchial edema). This medical emergency is most commonly associated with an allergic reaction to a medication, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. However, it can also be triggered by other substances, including contrast agents used in medical imaging procedures.

The swelling in toracele occurs due to the release of histamine and other mediators from mast cells, leading to vasodilation and increased vascular permeability. This results in the accumulation of fluid in the larynx or tracheobronchial tree, causing obstruction of the airway and respiratory distress.

The symptoms of toracele typically develop rapidly, often within minutes to hours after exposure to the triggering agent. Patients may present with difficulty breathing, a feeling of tightness in the throat, hoarseness, and stridor (a high-pitched sound made during breathing). If left untreated, toracele can lead to respiratory failure and death.

Diagnosis of toracele is primarily clinical, based on the patient's history and physical examination. However, laboratory tests and imaging studies may be ordered to rule out other causes of airway obstruction or to confirm the diagnosis.

Treatment of toracele is urgent and typically involves immediate discontinuation of the suspected allergen. Epinephrine, a first-line treatment, is often administered intravenously or intramuscularly to constrict blood vessels and reduce swelling. Other medications, such as corticosteroids and antihistamines, may also be used to manage symptoms and prevent recurrence.

Prevention of toracele involves identifying and avoiding known triggers, such as specific medications or contrast agents. Patients with a history of toracele should carry an epinephrine auto-injector and wear a medical alert bracelet. Regular follow-ups with an allergist or immunologist are also recommended to monitor for recurrence and to adjust treatment plans as needed.