Pleural effusion associated with the SAPHO syndrome.

the head of the patient and performs fiberoptic bronchoscopy (Olympus NFT3 Rhino-Laryngo Fiberscope; Olympus Optical; Hamburg, Germany) to prevent complications. The second physician performs the procedure. To prevent abnormal insertion and tracheal injury, the use of a single progressive conic dilator (Ciaglia Blue Rhino; William Cook Europe; Bjaeverskov, Denmark) is better than the use of several dilators with progressive size. In our experience, complications can occur even if we are satisfied with the immediate fiberoptic bronchoscopy result. I agree with Dr. Perkins’s opinion that fiberoptic bronchoscopy is required. Even better, it must be performed for a long time even after decannulation. Other methods can be performed to reduce tracheal impaction. A kit by Mallinckrodt (Tracheostomia translazingea Fautoni methode; Mallinckrodt Medical; Mirandola, Italy) uses a similar procedure as an endoscopic gastrostomy (internal to external procedure), but in our experience, this procedure is more complicated at bedside.