Bronchoscopic Management of Severe Airway Stenosis Caused by Past Tuberculosis

Abstract

Airway tuberculosis (TB) can result in luminal stenosis presenting months to years after completing antitubereulous therapy. Diagnosis can be difficult, and the first presentation could be an airway disaster. We analyzed the role of interventional bronchoscopy as an alternative to surgery in the management of severe airway stenosis from past TB. We reviewed the charts of seven patients, including three men and four women, who underwent bronchoscopic procedures for residual severe stenosis from TB diagnosed at a mean of 7.2 years (SD 8.2) earlier. The mean age at presentation of airway obstruction was 48 years (SD 12.5). Symptoms included cough (7), progressive dyspnea (7), and recurrent infections (3). A total of 11 lesions were detected in the trachea and the left main bronchus on bronchoscopy. All patients had at least 1 critical lesion with mean occlusion of 88% (SD 8.8) and mean length of 37 mm (SD 20.2). Out of the 11 lesions, severe tracheobronchomalacia was present in 7, and the airway was severely distorted in 6. Fibrosis was consistently present in all cases. All patients had dilatation with the balloon and the rigid bronchoscope followed by stenting, except for one patient who refused stenting and had dilatation performed via the flexible broncho scope. Nd-YAG laser was used in four out of the nine procedures. A total of nine silicone stents were easily deployed. Complications included bleeding (<100 mL) in three and transient hypoxia in one. Mean follow-up duration was 13.3 months (SD 8.7). Improvement in airway patency, symptoms, radiographic abnormalities, and spirometry were documented. Two patients had stent migration, and one had an associated granuloma. Mucous plugging occurred in one stent. Dilatation with the balloon and rigid tube, laser photoresection, and stenting are bronchoscopic techniques available for the treatment of tuberculous airway stenosis. Each technique is complimentary in yielding a better outcome of re-establishing luminal patency.