Different Approaches on Various Cases of Tracheal Stenosis

Abstract

Introduction: Narrowing of the airway caused by several factors is a serious condition manifesting different signs and symptoms. Immediate attention and treatment must be performed as this is a life-threatening condition. In the past decade, there has been massive advancement on management of airway stenosis. Some of these are stent placement, tracheal reconstruction and tumour debulking. This article focuses on 5 different cases with distinct strategies in conducting treatment. Objective: We performed this study to analyze the different techniques used in handling 5 patients with different causes of airway stenosis. Method: Between September 2012 and November 2013, we identified 5 patients diagnosed of central airway narrowing. We analyzed each case study, considered the pathology of the disease, treatment, prognosis, and improvement in quality of life. Case Reports: 1. A case of lung cancer stage III, post right upper lobe lobectomy, following irradiation and chemotherapy. Neck CT scan presented a demonstrable consolidative mass that caused pressure to the upper trachea and esophagus. Polyflex airway stent placement was successfully performed via rigid bronchoscopy. 2. A case of 46-year-old male, who presented progressive dyspneoa, hoarseness of voice, stridor, fever and cough underwent fiberoptic bronchoscopy which revealed tracheal stenosis. Polyflex airway stent was inserted without complications. Cytology report was positive for adenoid cystic carcinoma. 3. A case of esophageal cancer with metastatic brain tumour status postcraniotomy. The neck CT scan revealed a mass that invaded the posterolateral aspect of upper intrathoracic trachea. Rigid bronchoscopy for stent placement was done without difficulty. 4. A 27-year-old woman who is a foreign health care worker exposed to tuberculosis (TB) patients, was diagnosed of TB and underwent treatment for 6 months. 10 months later, she presented with stridor, wheezing, shortness of breath and dyspneoa. Bronchoscopy revealed narrowing near the mid-trachea. Tracheal resection and reconstruction under general anaesthesia were done. No untoward complications were noted post-surgery. 5. An asthmatic patient on bronchodilators has been complaining of dyspneoa. Chest CT scan revealed a lobulated well-defined soft tissue density at trachea. The mass was extracted via the combination of rigid and fiberoptic bronchosopes with snare and electrocautery. Conclusion: Airway stenosis is a life-threatening condition with severe complications caused by several factors. Treatment is individualized and management requires technical expertise. If caught early and treatment has been determined following diagnosis, improvement on quality of life and potential survival may be achieved.