Intrathoracic retroesophageal goiter causing tracheal stenosis.

A 65-year-old woman presented with stridor revealed a mass on a chest X-ray on physical examination. A huge goiter arising in the left lobe of the thyroid had extended retroesophageally and across the midline to the right side of the posterior mediastinum far caudally down to the level of the carina. The trachea was remarkably compressed. Surgery was performed via a combined thoracic and cervical approach, and the tumor was completely removed with resultant relief from stridor. The patient is presently doing well at 1 year after the operation.     

Intrathoracic retroesophageal goiter causing tracheal stenosis

A 65-year-old woman presented with stridor revealed a mass on a chest X-ray on physical examination. A huge goiter arising in the left lobe of the thyroid had extended retroesophageally and across the midline to the right side of the posterior mediastinum far caudally down to the level of the carina. The trachea was remarkably compressed. Surgery was perfomed via a combined thoracic and cervical approach, and the tumor was completely removed with resultant relief from stridor. The patient is presently doing well at 1 year after the operation.     

Treatment of tracheal cicatricial stenosis

Cicatricial stenosis and tumors are the main indications for tracheal surgery. From 1963 to January 2001 323 patients were operated for cicatricial stenosis of trachea. In 287 (88.9%) patients tracheal stenosis was iatrogenic after respiratory reanimation. In 191 (59.1%) patients tracheal stenosis located in cervical part of the trachea. In 67 of them it combined with stenosis of subplicalis part of the larynx. Lesion of cervical-upperthoracic trachea was seen in 57 (17.6%) patients, thoracic part--in 69 (21.4%). Total lesion of trachea was diagnosed in 6 (1.9%) patients, in 2 of them tracheal bifurcation and both main bronchi were involved in cicatricial process. Indications for surgery were in 238 (73.7%) patients. 85 (26.3%) patients underwent endoscopic treatment. The main operations were circular resection and staged reconstructive-plastic surgeries. 303 patients were discharged, 20 patients died, hospital lethality was 6.6%. Intra- and postoperative complications were seen in 93 (13.4%) cases. Good and satisfactory long-term results were achieved in 85.1% patients. Unsatisfactory long-term results were associated with postoperative complications.     

Y-shaped tracheobronchial stent for carinal and distal tracheal stenosis

(Received for publication on Sept. 11, 1996; accepted on Mar. 4, 1997)     

Candida infection in a stent inserted for tracheal stenosis after heart lung transplantation

Although there are many reports on the use of expandable metallic stents for treating an airway stenosis that develops after heart lung transplantation, complications from using these stents are rarely reported. We experienced a case of Candida infection in a stent that was placed to treat a tracheal stenosis after heart lung transplantation in an 11-year-old girl. The patient had progressive shortness of breath developed from the 5th postoperative week. Chest computed tomography and bronchoscopy revealed a stenosis at the level of the anastomosis. After repeated unsuccessful trials of endoscopic ablation of the granuloma, a Palmaz metallic expandable stent (8 × 30 mm) (Johnson and Johnson Interventional Systems Co, Warren, NJ) was placed, which was followed by immediate relief of the dyspnea. Bronchoscopy conducted immediately after the stent placement showed a free floating distal stent end, which needed to be followed up. The patient had been doing well for the next 9 months after stent placement when she again had shortness of breath develop. Endoscopic examination revealed an intraluminally growing fungal mass, which was particularly severe at the distal free edge of the stent. The culture yielded Candida albicans. Aggressive antifungal agents and surgical removal of the stent were planned, but the patient died 1 day after admission.     

Low frequency jet ventilation for stent insertion in a patient with tracheal stenosis

PURPOSE: Evaluate oxygen jet ventilation in a patient with tracheal stenosis undergoing stent insertion. CLINICAL FEATURES: Manual intermittent low frequency oxygen jet ventilation was used during general anesthesia for fibreoptic bronchoscopy and stent insertion in a patient with tracheal stenosis. Oxygen jets were delivered via a Sander's injector adapted to the proximal end of the endotracheal tube on one side, and open to room air on the other side. Adequate oxygenation and carbon dioxide removal were ensured throughout the procedure. CONCLUSION: Low frequency jet ventilation in a patient with tracheal stenosis provided adequate ventilation as well as a non- obstructed field during fibreoptic bronchoscopy and stent insertion.     

Self-made tracheal stomal stent using a tracheal T-tube

Adapting a silicone tracheal safe T-tube is a simple method to guarantee upper airway permeability. Its making and availability ease offers a cheap and valid option to avoid the complications of the tracheostomy tube.     

Treatment of congenital tracheal stenosis. Retrospective study of thirteen cases

Thirteen cases of congenital tracheal stenosis (CTS) were retrospectively studied in terms of operative indication and treatment. The intratracheal transverse ratio of the stenotic/normal diameter (stenotic ratio, SR) was obtained by chest X-ray, tracheogram or autopsy, as one of the parameters of stenosis. SR ranged from 0.14 to 0.50 (mean 0.35 +/- 0.13 SD). Two cases (SR = 0.14) received tracheal resection and reanastomosis successfully. In three cases with pulmonary artery sling (PAS), PA translocation was performed to release tracheal compression. One (SR = 0.49) had good result but two (SR = 0.20, 0.30) died from respiratory failure (RF) and autopsy revealed PAS. Four cases underwent surgery for congenital heart disease (CHD), 3 (SR = 0.41, 0.46, 0.49) had good results but one (SR = 0.36) died from RF. In four cases medically treated, 3 (SR = 0.40, 0.44, 0.50) improved with growth but one (SR = 0.25) died before operation due to RF and autopsy revealed PAS. When SR greater than or equal to 0.40, cases without PAS improved with conservative treatment, those with PAS improved by PA translocation, and those with CHD tolerated open heart surgery. When SR less than 0.40, tracheal reconstruction is indicated. Cases with PAS would require primary or staged operation of PA translocation + tracheal reconstruction. The most appropriate therapy should be selected on the basis of symptoms, associated diseases and parameter of tracheal stenosis, for instance "SR".     

气管支架置入术治疗气管恶性狭窄的并发症分析

目的探讨应用气管支架治疗气管恶性狭窄的并发症。方法回顾性分析1999年11月—2011年6月在局麻和数字减影血管造影机下应用气管支架治疗气管恶性狭窄的25例患者资料,其中6例置入Z型不锈钢支架,19例置入镍钛记忆合金支架,观察支架相关并发症。结果置入Z型不锈钢支架的6例患者中,所有支架置入后即刻完全扩张,2例出现支架移位,随访期中支架再狭窄3例,其中肿瘤增生性狭窄1例,黏稠痰液阻塞性狭窄1例,支架断裂伴肉芽增生性狭窄1例;置入镍钛记忆合金支架的19例患者中,术中无支架移位,2例即刻完全扩张,17例术后3天～3个月扩张完全,随访期内支架再狭窄2例,其中肿瘤增生性狭窄1例,肉芽增生性狭窄1例。所有患者术后呼吸困难即刻明显改善。结论应用气管支架治疗气管恶性狭窄有一定并发症,但仍是一种作用迅速、效果显著的治疗措施。     

Incorporated airway stent: a useful option for treating tracheal stenosis after metallic stenting

This study incorporated a silicone tracheal stent into a metallic stent in a complicated airway stenosis patient. The silicone tracheal stent provided a stable and patent airway. The patient was discharged smoothly after the procedure. At 5 months after surgery, the patient remained stable and resumed all daily activities without any respiratory symptoms.     

Bougienage and balloon dilation using a conventional tracheal tube for tracheobronchial stenosis before stent placement

In order to achieve urgent restoration of the airways in tracheobronchial stenosis and to make stent placement simpler and safer, we developed a method that allows combined bougienage and balloon dilation via the use of a conventional tracheal tube. Fifteen patients with tracheobronchial stenosis underwent bougienage and balloon dilation using a tracheal tube with a cuff attached, inserted via a tracheostomy, before stent placement. The conventional tracheal tube was inserted via a tracheostomy, the cuff was expanded at the stenotic site, and the tube was fixed to the tracheostomy and left in place for a few days until sufficient dilation was achieved. This procedure was conducted on the trachea in 10 patients, the left main bronchus in three patients, and the right main bronchus in two patients. In all patients, the procedure immediately relieved the obstructive symptoms and dilated the stenosis sufficiently. Thereafter, Dumon stents were inserted in 10 patients, dynamic stents in four patients, and an expandable metallic stent in one patient. The stents were introduced easily with no other dilation procedure after a mean of 5 days from the start of the procedure. For tracheobronchial stenosis, bougienage and balloon dilation using a tracheal tube with an integral cuff via a tracheostomy is a simple and safe method for achieving both urgent relief of airway stenosis and dilation before stent placement. Received: 20 May 1999/Accepted: 17 December 1999/Online publication: 25 April 2000     

A dumon stent inserted for bronchial stenosis causing a left bronchopericardial fistula: Report of a case

We present herein the case of a 59-year-old man in whom a Dumon stent, inserted as treatment for stenosis of the left main bronchus, caused a left bronchopericardial fistula. The patient initially presented with severe dyspnea caused by main bronchial stenosis of unknown origin for which a Dumon stent was inserted at a local hospital. The Dumon stent migrated to the endobronchus through the stenosis of the left main bronchus a few days later, and his dyspnea remained unresolved. He was subsequently referred to our department 6 months later, where a left pneumonectomy under supportive cardiopulmonary bypass through the femoral artery and vein was performed, and a postoperative pathological diagnosis of bronchial leiomyosarcoma was made. For this rare group of malignant tumors, early diagnosis permits complete surgical resection of the mass and offers the best prognosis. Excision of the tumor should be performed under cardiopulmonary bypass through the femoral vessels when a risk of sudden rupture of the pulmonary artery or vein exists for any reason.     

Treatment of postoperative tracheal granulation tissue with inhaled budesonide in congenital tracheal stenosis

Purpose

Tracheal obstruction by granulation tissue can compromise the postoperative course in congenital tracheal stenosis (CTS). Balloon dilatation and stenting may be required. Budesonide is a corticosteroid with topical anti-inflammatory effects. In 2008, we used inhaled budesonide for treatment of postoperative granulation tissue for the first time in CTS, resulting in significant improvement. The aim of this study was to evaluate the efficacy of inhaled budesonide for treatment of postoperative granulation tissue in CTS.

Methods

Retrospective chart review was conducted. From 2004 through 2011, we performed 39 tracheoplasties. Forced stenting ± balloon dilatation (S/B) was required when airway obstruction with tissue granulation was life-threatening. We compared the requirement for S/B between the early group without budesonide (2004–Nov. 2008, Early) and the late group with budesonide (Dec. 2008–2011, Late). Statistical analysis was performed using Fisher’s Exact test.

Results

Eleven of 22 in Early and 8 of 17 in Late were successfully extubated, never having had life-threatening tissue granulation. The remaining patients in each group (11 in Early and 9 in Late) required tracheostomies due to postoperative complication. Ten in Early and 5 in Late with tracheostomies developed granulation tissue. Of these patients, the 10 in Early required S/B, while none of the 5 in Late required S/B (P = .0003). Bronchoscopy demonstrated significant regression of granulation tissue in all cases treated with inhaled budesonide.

Conclusion

Inhaled budesonide is effective for treatment of tracheal granulation tissue in patients with tracheostomies after repair of CTS.     

Successful treatment of long-segmental tuberculous tracheal stenosis with combined Mongomery T-stent and Hood stent

We used combined Mongomery T-stent and Hood stent in a long segment (11 cm), benign tracheal stenosis after treatment with a standard Mongomery T-stent failed. Respiratory and phonation function was restored immediately after the procedure. The patient became pregnant 2 months later. Her baby was born at full-term with a smooth vaginal delivery. She was in good health 18 months after the operation.     

Surgical management of idiopathic tracheal stenosis.

Most nonmalignant upper tracheal stenoses are caused by prolonged endotracheal intubation or tracheostomy, and idiopathic stenosis is uncommon. A 43-year-old woman complained of increasing shortness of breath during exercise over a year prior to admission. She had no significant past medical history, including endotracheal intubation. Bronchoscopy and tracheal tomography revealed nonmalignant circumferential upper tracheal stenosis 20 mm long. Single-stage surgical resection with cricotracheal anastomosis completely relieved her respiratory symptoms. Idiopathic tracheal stenosis is extremely rare, and the treatment of choice is surgery.