Abstract
Central airway obstruction due to the tumor can present as near-complete tracheal obstruction. The results can be life-threatening requiring emergent intervention. Rigid bronchoscopy has been preferred for the management of central airway obstruction. However, there are relatively few studies comparing rigid bronchoscopy and flexible bronchoscopy in treating these cases. We describe a 61-year-old woman with a lower trachea tumor with ball valve occlusion of the left mainstem bronchus and complete occlusion of the right mainstem bronchus successfully managed with flexible bronchoscopy and iCAST® stent. We herein highlight the role of therapeutic flexible bronchoscopy with airway stenting as an efficacious treatment modality for the management of malignant central airway obstruction.
Highlights
Central airway obstruction refers to obstruction involving the trachea or mainstem bronchi [1]
When these tumors present as near-complete tracheal obstruction, the results can be life-threatening, requiring emergent tumor debulking or airway stenting by trained specialists
We present a case of malignant central airway obstruction with a ball valve mechanism involving the left main stem in a patient with renal cell carcinoma, which was successfully treated with flexible bronchoscopy and airway stenting
Summary
Central airway obstruction refers to obstruction involving the trachea or mainstem bronchi [1]. We present a case of malignant central airway obstruction with a ball valve mechanism involving the left main stem in a patient with renal cell carcinoma, which was successfully treated with flexible bronchoscopy and airway stenting. A 61-year-old woman with chronic obstructive pulmonary disease (COPD) and a recent diagnosis of a right hilar mass presented with four weeks of progressively worsening dyspnea and hemoptysis. She underwent emergent intubation for impending respiratory arrest. A flailing tumor was seen in the lower trachea with ball valve occlusion of the left mainstem bronchus and complete occlusion of the right mainstem bronchus (Video 1). She was later started on immunotherapy with Ipilimumab and Nivolumab
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