Tracheal tugging [Oliver-Cardarelli phenomenon, Oliver sign]
Tracheal tugging [Oliver-Cardarelli phenomenon, Oliver sign]: Excerpt from Nursing: Interpreting Signs and Symptoms
A visible recession of the larynx and trachea that occurs in synchrony with cardiac systole, tracheal tugging commonly results from an aneurysm or a tumor near the aortic arch and may signal dangerous compression or obstruction of major airways. The tugging movement, best observed with the patient's neck hyperextended, reflects abnormal transmission of aortic pulsations because of compression and distortion of the heart, esophagus, great vessels, airways, and nerves.
Action stat!
If you observe tracheal tugging, examine the patient for signs of respiratory distress, such as tachypnea, stridor, accessory muscle use, cyanosis, and agitation. If the patient is in distress, check airway patency. Administer oxygen, and prepare to intubate the patient if necessary. Insert an I.V. catheter for fluid and drug access, and begin cardiac monitoring.
History and physical examination
If the patient isn't in distress, obtain a pertinent history. Ask about associated symptoms, especially pain, and about history of cardiovascular disease, cancer, chest surgery, or trauma.
Then examine the patient's neck and chest for abnormalities. Palpate the neck for masses, enlarged lymph nodes, abnormal arterial pulsations, and tracheal deviation. Percuss and auscultate the lung fields for abnormal sounds, auscultate the heart for murmurs, and auscultate the neck and chest for bruits. Palpate the chest for a thrill.
Medical causes
Aortic arch aneurysm.A large aneurysm can distort and compress surrounding tissues and structures, producing tracheal tugging. The cardinal sign of this aneurysm is severe pain in the substernal area, sometimes radiating to the back or side of the chest. A sudden increase in pain may herald impending rupture—a medical emergency. Depending on the aneurysm's site and size, associated findings may include a visible pulsatile mass in the first or second intercostal space or suprasternal notch, a diastolic murmur of aortic insufficiency, and an aortic systolic murmur and thrill in the absence of any peripheral signs of aortic stenosis. Dyspnea and stridor may occur with hoarseness, dysphagia, brassy cough, and hemoptysis. Jugular vein distention may also develop along with edema of the face, neck, or arm. Compression of the left main bronchus can cause atelectasis of the left lung.
Hodgkin's disease.A tumor that develops adjacent to the aortic arch can cause tracheal tugging. Initial signs and symptoms include usually painless cervical lymphadenopathy, sustained or remittent fever, fatigue, malaise, pruritus, night sweats, and weight loss. Swollen lymph nodes may become tender and painful. Later findings include dyspnea and stridor; dry cough; dysphagia; jugular vein distention; edema of the face, neck, or arm; hepatosplenomegaly; hyperpigmentation, jaundice, or pallor; and neuralgia.
Thymoma.Thymoma is a rare tumor that can cause tracheal tugging if it develops in the anterior mediastinum. Cough, chest pain, dysphagia, dyspnea, hoarseness, a palpable neck mass, jugular vein distention, and edema of the face, neck, or upper arm are common findings.
Nursing considerations
▪ Place the patient in semi-Fowler's position to ease respiration and administer oxygen if needed.
▪ Administer a cough suppressant and prescribed pain medications.
▪ Be alert for signs of respiratory depression.
▪ Prepare the patient for diagnostic procedures, which may include chest X-rays, computed tomography scan, lymphangiography, aortography, bone marrow biopsy, liver biopsy, echocardiography, and a complete blood count.
Patient teaching
▪ Explain to the patient the underlying condition and its treatments.
▪ Discuss positions that will ease his breathing.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Raynaud's phenomenon
More Medical Textbooks Online about Raynaud's phenomenon
Review other book chapters online related to Raynaud's phenomenon:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Surveys relating to Raynaud's phenomenon
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
