Intrathoracic tracheal obstruction caused by a carotid mycotic aneurysm in a patient with deep neck infection--a case report.
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Upper airway obstruction secondary to a carotid mycotic aneurysm has not been previously reported. We describe a patient with a mycotic aneurysm associated with a deep neck infection and presenting with acute tracheal obstruction. Recognition of this condition is important to avoid inadvertent rupture of the aneurysm in the course of diagnostic aspiration or surgical drainage. Physical findings, including a pulsating mass and an arterial bruit, in addition to appropriate imaging studies, may be helpful in suggesting the diagnosis. In particular, both neck and chest contrast-enhanced computed tomography scans may give important clues to the presence of a vascular lesion. In a patient with an infected neck mass and tracheal compression, a common carotid mycotic aneurysm should be considered in the differential diagnosis. (+info)
Tracheal stent in the treatment of tracheal stenosis.
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The use of airway stents for the treatment of benign airway stenosis is increasingly advocated. However, the long-term safety and efficiency of these devices has not been established. We present a case of tracheal stenosis. which persisted despite open surgical and laser correction. The patient required tracheal stent insertion and is currently well with no respiratory difficulty. The use of metallic or silicon intraluminal stent remains appropriate in cases in which there is defined and relative short-term end point of treatment. (+info)
Superimposed high-frequency jet ventilation (SHFJV) for endoscopic laryngotracheal surgery in more than 1500 patients.
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BACKGROUND: Superimposed high-frequency jet ventilation (SHFJV), which does not require any tracheal tubes or catheters, was developed specifically for use in laryngotracheal surgery. SHFJV uses two jet streams with different frequencies simultaneously and is applied in the supraglottic space using a jet laryngoscope and jet ventilator. METHODS: Between 1990 and 2004, SHFJV was studied in 1515 consecutive patients (including 158 children requiring laryngotracheal surgery) prospectively. Ventilation was performed with an air/oxygen mixture and anaesthesia was administered i.v. RESULTS: Adequate oxygenation and ventilation was achieved in 1512 patients. Arterial blood gas analyses (BGA) were performed between 1990 and 1994; thereafter BGA was only performed in patients with high-grade stenosis of the larynx/trachea or high-risk patients [n=623, mean Pa(O(2)) 133.8 (39.4) mm Hg and mean Pa(CO(2)) 42.3 (10.1) mm Hg]. There were no significant changes in Pa(O(2)) or Pa(CO(2)) during the entire period of SHFJV. No complications secondary to the ventilation technique were observed; in particular, no barotrauma occurred. Three patients required tracheal intubation. SHFJV was also successfully used for laser surgery (n=312). It proved to be a safe mode of ventilation without any complications such as airway fire, major haemorrhage, or aspiration of debris. CONCLUSION: SHFJV is an advanced ventilation mode playing a pivotal role in the (open) ventilatory support/ventilation of patients with laryngotracheal stenosis. It is particularly indicated in cases of severe stenosis and offers optimal conditions for laryngotracheal surgery, including laser surgery and stent implantation techniques. (+info)
Severe airway stenosis associated with Crohn's disease: case report.
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BACKGROUND: Symptomatic respiratory tract involvement is not common in Crohn's disease. Upper-airway obstruction has been reported before in Crohn's disease and usually responds well to steroid treatment. CASE PRESENTATION: We report a case of a 32-year old patient with Crohn's disease who presented with progressively worsening dyspnea on exertion. Magnetic Resonance Imaging of the chest and bronchoscopy revealed severe tracheal stenosis and marked inflammation of tracheal mucosa. Histopathology of the lesion showed acute and chronic inflammation and extended ulceration of bronchial mucosa, without granulomas. Tracheal stenosis was attributed to Crohn's disease after exclusion of other possible causes and oral and inhaled steroids were administered. Despite steroid treatment, tracheal stenosis persisted and only mild symptomatic improvement was noted after 8 months of therapy. The patient subsequently underwent rigid bronchoscopy with successful dilatation and ablation of the stenosed areas and remission of her symptoms. CONCLUSION: Respiratory involvement in Crohn's disease might be more common than appreciated. Interventional pulmonology techniques should be considered in cases of tracheal stenosis due to Crohn's disease refractory to steroid treatment. (+info)
Stenting allows weaning and extubation in ventilator- or tracheostomy dependency secondary to benign airway disease.
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Central airway obstruction can cause severe respiratory insufficiency leading to mechanical ventilation (MV) or artificial airway (AA) dependency. Interventional bronchoscopic procedures have been reported to be of help in weaning patients with malignant airway stenoses from mechanical ventilation, whereas their use in benign disease is only anecdotal. The objectives of this study are to evaluate early, intermediate and long-term outcome of interventional bronchoscopy and stent placement in the treatment of MV/AA dependency due to benign airway obstruction. In a retrospective cohort analysis for the period 1999-2004, we evaluated 15 consecutive ICU patients with documented benign central airway obstruction, who were referred for bronchoscopic management of their condition after multiple failed attempts at weaning from MV or decannulation of the AA. Indications for bronchoscopic treatment were surgery refusal, medical or surgical inoperability, or absence of alternative treatment options. Malacia, post-intubation stenosis and goiter were the main causes of airway obstruction and MV/AA dependency. All patients were treated by means of rigid bronchoscopy, dilatation procedures and stent insertion. All but one patient (93.3%) were successfully and permanently extubated/decanulated immediately after the bronchoscopy. Minor complications occurred in 6 patients (40%) leading to a second intervention. All complications could be managed endoscopically and long-term follow up was uneventful. Interventional bronchoscopy with stent insertion can allow successful withdrawal from MV/AA and can offer longstanding airway patency in selected ventilator- or tracheostomy-dependant individuals with benign airway stenoses,when surgery in not feasable or contra-indicated. (+info)
Both bronchial and vascular stenting followed by chemoradiotherapy for locally advanced non-small cell lung cancer.
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Airway and vascular constrictions are expected problems for lung cancer patients. The clinical course of a patient in whom stents were inserted in 3 constriction regions is reported. A 72-year-old man with advanced primary lung cancer (squamous cell carcinoma stage IIIB) developed suffocating constriction of the trachea and showed superior vena cava (SVC) syndrome. Self-expandable metal stents were inserted into the trachea, SVC and left subclavian vein and the patient was treated by radiotherapy and weekly irinotecan. Within 5 months of treatment, complete local control was achieved and there was no reconstriction. Both endobronchial and endovascular stenting prior to antitumor therapy may be beneficial in the treatment of locally advanced cases of lung cancer. (+info)
Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents.
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Minimally invasive diagnostic and therapeutic approaches in medicine have been applied for a more selective and tailored approach to reduce patients' morbidity and mortality. The efficacy of interventional pulmonology for palliation of patients with central airways obstruction has been established and its curative potential for intralesional treatment of early cancer has raised great interest in current screening programmes. This is due to the fact that surgical resection and systemic nodal dissection as the gold standard is relatively morbid and risky, especially when dealing with individuals with limited functional reserves due to smoking-related comorbidities, such as chronic obstructive pulmonary disease. Furthermore, such comorbidities have been proven to harbour early stage lesions of several millimetres in size without involvement of nodal disease that may be amenable to local bronchoscopic treatment. Therefore, the success of minimally invasive strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. Maximal preservation of quality of life is a prerequisite in successfully dealing with individuals at risk of harbouring asymptomatic early lung cancer, to prevent aggressive surgical diagnostic and therapeutic strategies since overdiagnosis remains an issue that is heavily debated. In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation and stenting are techniques that can provide immediate relief, in contrast to cryotherapy, brachytherapy and photodynamic therapy with delayed effects. With curative intent, intraluminal techniques that easily coagulate early stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease. (+info)
A case of cuff stenosis following tracheostomy responding well to T-tube stent insertion: with special reference to methods of dilating the stenosed site.
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A 74-year-old man, receiving home oxygen therapy (HOT), required tracheal intubation and artificial ventilation because of methicillin-resistant staphylococcus aureus (MRSA)-induced pneumonia. Tracheostomy was additionally performed. One month later, he had recovered from pneumonia and the tracheostomy tube was withdrawn, allowing the patient to be discharged. One month after discharge, the patient began to complain of wheezing and difficulty in breathing and was thus admitted again to the hospital. Emergency bronchoscopy revealed cuff stenosis. A bronchofiberscope, 4.8 mm in outer diameter (o.d.), was unable to pass through the stenosed site. After the airway was secured by passing a Mini-Trach II tube (4.0 mm in inner diameter (i.d.) and 5.4 mm o.d.) through the stenosed site via the previous tracheostomy stoma, we changed the inserted tracheal tube every other day, replacing it each time with a tube of progressively larger i.d. and o.d. We went from 5.0 mm i.d. (6.9 mm o.d.) to 6.0 mm i.d. (8.2 mm o.d.), 7.0 mm i.d. (9.6 mm o.d.) and finally to 8.0 mm i.d. (10.9 mm o.d.). In this way, the stenosed site was gradually dilated. Finally, a silicon T-tube with 9.0 mm i.d. (11.0 mm o.d.) was inserted via the tracheostomy hole into the trachea and left there. At present, 2 years after the procedure, the patient is continuing HOT and is being followed at an outpatient internal medicine clinic. Cuff stenosis affects the trachea concentric-circumferentially and often relapses even after laser therapy. For these reasons, stent insertion is usually considered as necessary when dealing with cuff stenosis. Our technique of tracheal dilation is safe and simple, and does not require any special device or tool other than tracheal tubes. We report that silicon T-tube stents are optimal for treatment in cases of cuff stenosis. (+info)