Main Bronchus Research Articles

The first experience of using a self-expanding metal Y-stent in a patient with decompensated tumor stenosis of the trachea and main bronchi

The first experience of using a self-expanding metal Y-stent in a patient with decompensated tumor stenosis of the trachea and main bronchi

Primary pulmonary adenoid cystic carcinoma- clinicopathological features and predictors of poor outcome.

Primary pulmonary adenoid cystic carcinoma is a rare disease. Its clinico-pathological features, course of disease, therapeutic strategy, and survival data have not been fully elucidated. We aimed to study the clinicopathological characteristics of primary pulmonary adenoid cystic carcinomas in north India. This study was a retrospective, single-centre, cohort study. The database of the hospital was searched for a period of seven years to identify all patients with primary pulmonary adenoid cystic carcinoma. Out of 6050 lung tumors, 10 were primary adenoid cystic carcinomas. The mean age of diagnosis was 42 (±12) years. Six patients had the lesion in the trachea, main bronchus or truncus intermedius and four had parenchymal lesions. Seven patients had resectable tumours. Three patients achieved an R0 resection, two achieved R1 resection and two had R2 resection. On histopathological examination, almost all of the patients had cribriform pattern. Only four patients (57.1%) showed positivity for TTF-1 staining. The five-year survival of patients with resectable tumour and un-resectable tumour was 85.7% and 33.3%, respectively (P = 0.01). The predictors of poor outcome included non-operability of the tumour, presence of metastasis at the time of diagnosis, and macroscopically positive tumour margin during surgery. Primary pulmonary adenoid cystic carcinoma is a unique and rare tumour that affects relatively younger individuals, males and females, as well as smokers and non-smokers equally. The features of bronchial obstruction are the most common. Surgery is the primary modality of treatment and completely resectable lesions have the best prognosis.

Primary Endobronchial Plasmacytoma with Mediastinal Lymph Nodes treated with Radical Radiotherapy: A Case Report with Review of Literature

Malignant proliferation of plasma cells arising outside the bone marrow or osseous sites is known as extramedullary plasmacytoma. Solitary Extramedullary Plasmacytoma (SEP) are commonly located in upper respiratory tract and sinuses. Involvement of lower respiratory tract is rarely seen in case of SEP. Here, the authors report a case of endobronchial plasmacytoma in a 41-year-old male patient, without any medical risk factors presenting with complaint of blood stained sputum. Radiological imaging confirmed endobronchial mass in right main bronchus. Histopathology with immunohistochemistry confirmed the diagnosis of plasmacytoma. Work-up for multiple myeloma was negative. Thus, patient was subsequently planned for radical radiotherapy for the primary disease. The patient tolerated the treatment well and was asymptomatic at the time of last follow-up. Solitary Endobronchial Plasmacytoma (SBP) is a rare presentation of SEP. Radical radiotherapy yields excellent local control rates and symptomatic benefit. Close surveillance for development of multiple myeloma is required at periodic intervals.

Endobronchial Inflammatory Myofibroblastic Tumor in a 3-Year-Old Child

AbstractInflammatory myofibroblastic tumor (IMT) is a mesenchymal tumor that can occur at any age. However, it is primarily seen in children, with the most common site being in the lung parenchyma, usually present with rare endobronchial lesions. This case reports the incidence in a 3-year-old girl diagnosed with pericardiac pneumonia treated with antibiotics with no clinical improvement. A chest computed tomography (CT) scan identified a 1.5-cm lesion in the left main bronchus. Bronchoscopy revealed complete obstruction of the left main stem bronchus. A left posterolateral thoracotomy was performed. Additionally, a left sleeve upper bronchial resection was conducted under fibroendoscopic control. Definitive histology confirmed IMT. After 2 years of endoscopic follow-up, there is no evidence of recurrence.

Mounier-Kuhn With Multiple Diverticula

A male in his 60s, nonsmoker, with history of gastroesophageal reflux disease, hiatal hernia repair, and recurrent bronchitis presented to an otolaryngology subspecialty clinic with 1 month of mild dyspnea. Office bronchoscopy identified a paratracheal diverticulum and abnormal scar tissue in the mainstem bronchi bilaterally. The trachea demonstrated posterior scar bands with intermittent dilations (Figure 1). Computed tomography (CT) imaging revealed a 44×18–mm cystic, extrapulmonary lesion along the right side of the trachea, as well as tracheobronchomegaly (Figure 2).

Troubleshooting of Unusual and Challenging Presentation in Pediatric Airway Emergency: A Case Series

Abstract This case series explores three distinct pediatric airway complications and their successful management through innovative on-table procedures. The first case involves a 10-month-old male baby who presented with a broken tracheostomy tube lodged within the trachea as a foreign body. The second case features a 5‐year‐old boy with left main bronchus stenosis, while the third case highlights an 8‐year‐old girl with subglottic and mid‐tracheal stenosis. In each case, conventional treatment options posed significant challenges due to the unique nature of the airway obstructions. However, the medical teams demonstrated remarkable ingenuity by implementing on-table innovations to address these critical situations. The cases were approached with a combination of advanced imaging, real-time decision-making, and tailored interventions. This case series underscores the importance of adaptability and creative problem-solving in pediatric airway emergencies. Through these cases, we showcase the potential for successful outcomes when health-care professionals utilize on-table innovation, enabling them to swiftly and effectively manage complex pediatric airway complications, ultimately improving patient outcomes and quality of life. These experiences offer valuable insights for medical practitioners facing similar challenging scenarios in their clinical practice.

TRACHEOBRONCHIAL MORPHOMETRY CORRELATES WITH DEMOGRAPHIC CHARACTERISTICS AND INFECTIONS IN CRITICALLY ILL PATIENTS.

Tracheal measurements in the intensive care unit (ICU) are important for the choice of endotracheal tube and may correlate with patient demographic characteristics and infections. The study included 42 surgical patients, age 60 [48-71] years, who underwent diagnostic chest computed tomography (CT) scans during treatment in the ICU, Osijek University Hospital, in 2019 and 2020. CT scans were analyzed using AW Server 3.2. Measurement analysis showed that the diameters of the tracheobronchial tree, the length of the trachea and left main bronchus were significantly larger in men compared to women (p<0.05 all). The smallest tracheal upper diameter was 15.25 [IQR 11.8-18.8] mm vs. 17.95 [13.55-20.05] mm in septic and nonseptic patients, respectively (p=0.028). A total of 26 patients who underwent CT scans developed nosocomial pneumonia. It was right-sided in 15, left-sided in 6 and bilateral in 5 patients, and correlated significantly with the left main bronchus length (ρ=0.515, p=0.007). No correlation was observed between tracheobronchial measurements and length of ICU treatment, number of hours spent on mechanical ventilation, or survival. A larger study could provide better data on the importance of tracheobronchial tree measurements in ICU patients.

Respiratory failure in spinal muscular atrophy: A case report and review of literature

Spinal muscular atrophy (SMA) type 2 is a neuromuscular disorder of childhood with high morbidity and mortality caused by the deletion of SMN1 gene (gene 1 of motor neuron survival), located at chromosome 5. It is the respiratory complications that account for the majority of deaths in SMA. This report describes an 18-year-old male patient diagnosed with SMA type 2, who had shortness of breath for 2 weeks and cough for 1 week. CT-Thorax revealed left lung collapse due to mucoid impaction in the left main bronchus. Bronchoscopy was challenging in this case due to severe kyphoscoliosis, and impacted mucus was extracted using bronchoscopy-guided forceps biopsy. Repeat X-ray of the chest following treatment showed no evidence of collapse, and patient was discharged in a stable condition with mucolytics and antibiotics.

T-tube気管支内異物例

Airway foreign bodies may cause recurrent pneumonia and atelectasis, which could be fatal; therefore, early diagnosis and removal are important. We report the case of a 76-year-old man who underwent total laryngectomy for laryngeal cancer (cT3N0M0) who presented with a foreign body (T-tube) lodged in his airway. Postoperatively, the permanent tracheostomy was observed to be stenotic, and we inserted a T-tube to maintain patency of the tracheostomy. We observed a gradual increase in sputum accumulation, necessitating frequent suctioning. Follow-up computed tomography performed a few weeks later for comorbid interstitial pneumonia revealed a foreign body in the left main bronchus. We performed bronchoscopy for removal of the bronchial foreign body, which proved to be the T-tube.

Isolated bronchoplastic procedure for typical carcinoid of the left lung

Lung carcinoids (LC) comprise neuroendocrine lung tumors of low (typical carcinoid) and intermediate (atypical carcinoid) grade of malignancy accounting for less than 2% of all lung neoplasms. In Europe, annual incidence of LC varies from 0.2 to 2 per 100 000. This value increased dramatically over the past 30 years. One of the causes is improvement of diagnostic methods. Compared to aggressive high-grade neuroendocrine lung cancer, natural course of early-stage LC is usually indolent. Therefore, surgery with preservation of as much normal lung tissue as possible is preferable for resectable tumors. Nevertheless, the number of isolated bronchial resections with preservation of the entire lung tissue is relatively small, and these procedures remain technically complex interventions. We present isolated resection of interlobular spur, lower medial wall of distal part of the left main bronchus and proximal part of the lower lobular bronchus for typical carcinoid with monobronchial anastomosis and preservation of the entire lung parenchyma.

Total Unilateral Collapsed Lung- A Sequela of Pulmonary Tuberculosis- and Pregnancy Outcome

Lung tissue damage after pulmonary tuberculosis is common and can result in persistent pulmonary disability with negative influence on a patient’s quality of life. On the other hand, a COVID-19 infection in a previously treated tuberculosis patient with residual pulmonary abnormalities imposes an increased risk of death. On their own, both of these diseases can have a devastating effect on a patient’s pulmonary system and as such be the cause of disability or even death. In this case report of total atelectasis of the left lung due to obliteration of the left main bronchus after tuberculosis treatment, we present a pregnant patient, who despite a significant reduction in pulmonary function, managed to have a pregnancy with favorable outcome. Thereafter the patient even recovered from a COVID-19 infection, illustrating resilience of the human body.

Development and Validation of Coding Algorithms to Identify Patients with Incident Non-Small Cell Lung Cancer in United States Healthcare Claims Data.

We sought to develop and validate an incident non-small cell lung cancer (NSCLC) algorithm for United States (US) healthcare claims data. Diagnoses and procedures, but not medications, were incorporated to support longer-term relevance and reliability. Patients with newly diagnosed NSCLC per Surveillance, Epidemiology, and End Results (SEER) served as cases. Controls included newly diagnosed small-cell lung cancer and other lung cancers, and two 5% random samples for other cancer and without cancer. Algorithms derived from logistic regression and machine learning methods used the entire sample (Approach A) or started with a previous algorithm for those with lung cancer (Approach B). Sensitivity, specificity, positive predictive values (PPV), negative predictive values, and F-scores (compared for 1000 bootstrap samples) were calculated. Misclassification was evaluated by calculating the odds of selection by the algorithm among true positives and true negatives. The best performing algorithm utilized neural networks (Approach B). A 10-variable point-score algorithm was derived from logistic regression (Approach B); sensitivity was 77.69% and PPV = 67.61% (F-score = 72.30%). This algorithm was less sensitive for patients ≥80 years old, with Medicare follow-up time <3 months, or missing SEER data on stage, laterality, or site and less specific for patients with SEER primary site of main bronchus, SEER summary stage 2000 regional by direct extension only, or pre-index chronic pulmonary disease. Our study developed and validated a practical, 10-variable, point-based algorithm for identifying incident NSCLC cases in a US claims database based on a previously validated incident lung cancer algorithm.

Long-term efficacy and safety of the Dumon stent for treatment of benign airway stenosis.

The long-term efficacy of the Dumon stent in the treatment of benign airway stenosis is unclear. The objective of this study was to evaluate the long-term efficacy and safety of the Dumon stent in patients with benign airway stenosis. We retrospectively reviewed patients with benign airway stenosis who were treated with a Dumon stent at the First Affiliated Hospital of Guangzhou Medical University between March 2014 and October 2021. We included patients with successful removal of silicone stents after implantation. The clinical data and information on bronchoscopic interventional procedures and related complications were collected and analyzed. Ninety-nine patients with benign airway stenosis were included. The stent was placed mainly in the trachea (44.4%) and left main bronchus (43.4%). The main type of stenosis was post-tuberculosis bronchial stenosis (57.6%). The overall cure rate was 60.6%. Stent-related complications included retention of secretions (70.7%), granuloma formation (67.7%), stent angulation (21.2%), and stent migration (12.1%). The stent was less effective for left main bronchus stenosis (p = 0.012). Multivariate logistic regression analysis identified that stent placement for more than 13 months, a stent-intervention number of ⩽ 1 predicted a favorable outcome. The efficacy and safety of the Dumon stent for benign airway stenosis need improvement. The stent is less effective for left main bronchus stenosis; regular follow-up is required in such cases. Stent placement for > 13 months and no more than once stent intervention within a 6-month period were associated with a favorable outcome.

Fatal Stent-Associated Respiratory Tract Infection Caused by K64-ST11 KPC-2-Producing Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae: A Rare Case Report.

Objectives: This study reported a fatal stent-associated respiratory tract infection (SARTI) caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP). Case: A bare-metal stent in the left main bronchus and a Y-shaped stent graft in the tracheal bronchus were placed successively in a 50-year-old woman due to shortness of breath after undergoing multiple chemotherapy treatments for lung cancer. Unfortunately, the followed SARTI and lung abscess in our patient caused by CR-hvKP eventually led to the death of the patient, despite our aggressive clearing of phlegm and potent antibiotics. The genomic analysis showed it was caused by a KPC-2-producing extensively drug-resistant K64-ST11 hypervirulent K. pneumoniae harboring several virulence and antimicrobial resistance genes. Conclusion: This study highlights the risk of SARTI caused by CR-hvKP in immunocompromised individuals.

A Prospective Study of Foreign Bodies in Aero-Digestive Tract at a Tertiary Care Center in Eastern Nepal

Background Aero-digestive tract foreign body (FB) is a common emergency dealt by the otolaryngologists. Airways FB have been a major cause of morbidity and mortality. Management of FB depends on the site of impaction and types of it. The study aimed to find out the incidence, types and complications of FB encountered in aerodigestive tract. Methods A hospital-based prospective study was conducted among the patients with aero digestive FB presented and managed at the department of ENT and HNS from August 2015 to July 2017. A self-designed proforma was used to collect the relevant data. A descriptive analysis was made of the frequency distribution of qualitative variables. The findings were presented as tables and graphs. Results A total of 276 patients were treated for FB in aero-digestive tract and 158 (57.25%) patients were male. 90 (32.6%) cases of FB occurred in age group of 1-10 years. Ninety six cases of foreign body (34.78%) were chicken bone followed by other bone (20.65%) and coin (18.12%). All cases of coin were seen in children &lt;13 years old and disc Battery in children &lt;10 years old. Out of 276 cases of foreign bodies, 254 (92.03%) were in upper digestive tract and 22 (7.97%) in airways. About 140 (50.72%) were in cricopharynx, 103 (37.32%) in esophagus and 11 (3.99%) in other sites in intestine.Complications were seen in 10 (3.62%) cases and retropharyngeal abscess was the most common (60%). Conclusion Cricopharynx was the most common site of FB lodgment in the digestive tract. Right main bronchus was the commonest site of lodgment of inhaled FB. Seeds, nuts, whistles, small toys were commonly seen obstructing the airway in children. They need to be trained not to keep these things in the mouth.

A Case of Bilateral Bronchial Foreign Body

Foreign body (FB) aspiration remains a serious health problem, particularly in children. The complications due to occlusion by FB or related to procedures for removal can lead to morbidity and mortality. Most of the FBs are located in the unilateral bronchus, however, the organic FB can be multiple or bilaterally located when children chewed the FB. Here, we present a case of successful retrieval of bilateral bronchial FBs. Preoperatively, FB in the left main bronchus was diagnosed, however, FB of the right upper bronchus was not definitive on X-ray and CT scan. During the rigid bronchoscopy, occult FB in the right upper bronchus was detected and successfully removed.

Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review

Fentanyl is a synthetic L-opioid receptor agonist, approximately 100 times more potent than morphine, that is experiencing an upward trend in the field of abuse. Fentanyl patches' abusive consumption can occur either by transdermal absorption or through other atypical and ingenious routes. In the present case, a 29-year-old man with a history of illicit drug use was found dead in a suburban neighborhood of an Italian city. At autopsy, lungs appeared increased in weight and showed minute subpleural hemorrhages. Airways contained abundant reddish foamy material; in addition, a fentanyl patch protective film was found inside the left main bronchus. Toxicological analysis revealed the presence of morphine, fentanyl, BEG and ethyl alcohol in peripheric blood; 6-MAM was also revealed in urine. Findings collected during post-mortem investigations allowed us to identify fentanyl consumption as the cause of death. Fentanyl consumption presumably took place by chewing of a transdermal patch, with subsequent aspiration of the protective film. The pathophysiology of death can be identified as combined respiratory failure-both central suppression and a fentanyl-induced increase in muscular stiffness; a further minor contribution may be identified in the mechanical airflow obstruction caused by the presence of the protective film at the bronchial level.

Infant in extremis: respiratory failure secondary to lower airway infantile hemangioma

BackgroundInfantile hemangiomas (IHs) are vascular tumors that commonly affect infants and usually regress spontaneously or can be easily treated as an outpatient with topical beta-blockers. However, IHs that present in the airway may cause life-threatening symptoms due to airway obstruction or risk of bleeding. Here we present the first documented case of an infant with rapid deterioration and acute respiratory failure secondary to a lower airway hemangioma.Case presentationThis 3-month-old male initially presented in respiratory distress with symptoms consistent with a viral respiratory infection, however showed no clinical improvement with standard therapies. An urgent CT scan revealed a mass occluding the right mainstem bronchus. Upon transfer to a tertiary care facility, he developed acute respiratory failure requiring emergent intubation and single lung ventilation. The availability of multiple subspecialists allowed for stabilization of a critically ill child, expedited diagnosis, and ultimately initiation of life-saving treatment with beta blockers. After 17 total hospital days, he was extubated successfully and discharged home in good condition.ConclusionsWhile IH is a rare cause of infantile respiratory distress, we present multiple pearls for the general pediatrician for management of IHs of the airway.

Foreign Body Aspiration in Children: Review of 198 Cases from Anesthesiology Perspective

Background: Tracheobronchial foreign body aspiration is an emergency in childhood. Rigid bronchoscopy is used for diagnosis and treatment. In our retrospective study, we aimed to evaluate anesthesia man-agement, age, gender, intraoperative blood pressure, pulse, saturation, intraoperative and postoperative complications, foreign body type and localization and length of hospitalization.Materials and Methods: The file of 198 pediatric patients who underwent rigid bronchoscopy by pediatric surgery with the diagnosis of foreign body aspiration in Harran University Medical Faculty Hospital be-tween 2016-2018 were retrospectively analyzed. All cases were managed under general anesthesia. The anesthesia management, age, gender, intraoperative blood pressure, pulse, saturation, intraoperative and postoperative complications, foreign body and localization, length of stay were obtained from patient records and retrospectively evaluated.Results: Localization of foreign bodies were found to be 4.5% in trachea, 48% in right main bronchus and 33.9% in the left main bronchus. 25.3% of foreign bodies were seed, 25.62% were peanuts and 5.62% were organic substances such as beans, needle was removed in 7.6% cases, and toy pieces was removed in 9.6% cases respectively. Low levels of saturation, hypercarbia, arrhythmia, laryngospasm and bron-chospasm were observed as complications of anesthesia.Conclusions: Foreign body aspiration is an emergency that requires early diagnosis and urgent interven-tion. It is important to be aware of the complications that may occur during anesthesia and momentous to be intervened by an experienced team.

The rare thoracic complication: perforation of gastric fundus ulcer: a case report

BackgroundGastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012, https://doi.org/10.2169/internalmedicine.51.6823, Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136, Kathayanatt et al. in Lung India 37(2):174–175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy.Case presentationA 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report.ConclusionsAlthough, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.