Kommerell’s Diverticulum: An Unusual Cause of Chronic Cough

A 62-year-old male presented to the outpatient department of chest with history of dry cough since two months and swelling on the anterior aspect of neck of 30-year duration. Physical examination revealed a goitre. However, further imaging studies revealed presence of another associated pathology, a Kommerell's diverticulum in association with a right aortic arch with aberrant left subclavian artery. The enlarged thyroid was not compressing the trachea, and its occurrence in this case could be incidental. The diverticulum was considered as the cause of chronic cough in our case as it was causing tracheal compression, and also there were no other obvious causes which could explain the symptom. Vascular anomalies such as Kommerell's diverticulum, though uncommon, should be considered in the differential diagnosis of chronic cough particularly when other common causes have been ruled out

Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy

Dexmedetomidine, an α2 agonist, has demonstrated its effectiveness as a sedative during awake intubation, but its utility in fiberoptic bronchoscopy (FOB) is not clear. We evaluated the effects of midazolam and dexmedetomidine on patient’s response to FOB. The patients received either midazolam, 0.02 mg/kg (group M, n=27), or dexmedetomidine, 1 µg/kg (group D, n=27). A composite score of five different parameters and a numerical rating scale (NRS) for pain intensity and distress were used to assess patient response during FOB. Patients rated the quality of sedation and level of discomfort 24 h after the procedure. Ease of bronchoscopy, rescue medication requirement, and haemodynamic variables were noted. Ideal or acceptable composite score was observed in 15 and 26 patients, respectively, in group M (14.48 ± 3.65) and group D (9.41 ± 3.13), p<0.001. NRS showed that 11 patients in group M had severe pain and discomfort as compared to one patient with severe pain and two with severe discomfort in group D during the procedure, p<0.001. Rescue midazolam requirement was significantly higher in group M (p=0.023). We conclude that during FOB, under topical airway anaesthesia, IV dexmedetomidine (1 µg/kg) provides superior patient comfort and tolerance as compared to IV midazolam (0.02 mg/kg)