Main Bronchus Research Articles

A voluminous tumour of the tracheal bifurcation.

The tracheal bifurcation is the point at which the trachea splits into the left and right main stem bronchus conducting to the lungs. Primary tumours of the tracheal bifurcation are rare. We report images of an adenoid cystic carcinoma of the tracheal bifurcation diagnosed accidentally following recurrent episodes of haemoptysis

Verrucous carcinoma of the esophagus with complete response after chemoradiotherapy

BackgroundVerrucous carcinoma of the esophagus (VCE) is a rare tumor that is difficult to diagnose. In most cases, biopsies show nonspecific inflammatory and hyperkeratotic changes and do not show malignant findings. Most VCEs are slowly growing, locally advanced tumors with few metastases. Treatments for VCE are the same as for normal esophageal cancer, involving combined chemotherapy, surgical resection, and radiation therapy. However, it has been reported that VCE has a poor response to radiation or chemoradiotherapy (CRT). A case of VCE with complete response (CR) after CRT is presented.Case presentationA 70-year-old man was found to have white, irregular esophageal mucosa 4 years earlier. He had been followed up as an outpatient as having candidal esophagitis. However, his tumor grew gradually, and biopsy was performed by endoscopic mucosal resection (EMR). He was finally diagnosed with VCE. He had no metastases to distant organs, but some lymph node metastases were suspected. The tumor invaded his left bronchus. The esophagostomy and gastrostomy were constructed as emergent procedures. The patient then underwent definitive CRT. 4 weeks after the end of CRT, two-stage esophagectomy was performed. First, he underwent esophagectomy with thoracic lymph node dissection. A latissimus dorsi flap was patched to the bronchus after primary suture of the hole. 6 weeks later, reconstruction of the gastric tube was performed through the antethoracic route. The pathological findings showed CR to CRT, with no proliferative cancer cells in the specimen. The patient has had no recurrence for three and half years after the resection.ConclusionsWe presented a locally advanced VCE that achieved CR to CRT. In cases that have some difficulty for local resection, CRT might be an appropriate treatment for VCE.

Minimally invasive resection of congenital tracheobiliary fistula with thoracoscopic cholangiography

Minimally invasive resection of congenital tracheobiliary fistula with thoracoscopic cholangiography

Dose-volume-based evaluation of convolutional neural network-based auto-segmentation of thoracic organs at risk.

The geometrical accuracy of auto-segmentation using convolutional neural networks (CNNs) has been demonstrated. This study aimed to investigate the dose-volume impact of differences between automatic and manual OARs for locally advanced (LA) and peripherally located early-stage (ES) non-small cell lung cancer (NSCLC). A single CNN was created for automatic delineation of the heart, lungs, main left and right bronchus, esophagus, spinal cord and trachea using 55/10/40 patients for training/validation/testing. Dice score coefficient (DSC) and 95th percentile Hausdorff distance (HD95) were used for geometrical analysis. A new treatment plan based on the auto-segmented OARs was created for each test patient using 3D for ES-NSCLC (SBRT, 3-8 fractions) and IMRT for LA-NSCLC (24-35 fractions). The correlation between geometrical metrics and dose-volume differences was investigated. The average (±1 SD) DSC and HD95 were 0.82±0.07 and 16.2±22.4mm, while the average dose-volume differences were 0.5±1.5Gy (ES) and 1.5±2.8Gy (LA). The geometrical metrics did not correlate with the observed dose-volume differences (average Pearson for DSC: -0.27±0.18 (ES) and -0.09±0.12 (LA); HD95: 0.1±0.3mm (ES) and 0.2±0.2mm (LA)). After post-processing, manual adjustments of automatic contours are only needed for clinically relevant OARs situated close to the tumor or within an entry or exit beam e.g., the heart and the esophagus for LA-NSCLC and the bronchi for ES-NSCLC. The lungs do not need to be checked further in detail.

Hair: An Unusual Foreign Body in Airways Presenting with Haemoptysis in an Adult Patient

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Management of Inedible Airway Foreign Bodies in Pediatric Rigid Bronchoscopy: Experience From a National Children's Regional Medical Center in China.

The aim of this study is to analyze the characteristics of inedible airway foreign bodies in pediatric rigid bronchoscopy to facilitate the improvement of management and technology. This retrospective analytical study was performed from January 2017 to June 2020. All admissions of pediatric patients (age<18 years) with foreign-body aspiration diagnosis codes ([ICD]-10:T17 300, T17 400, T17 500 and T17 900) and procedure codes (33.7801) were extracted. Age, sex, preoperative history and imaging data, surgical records, length of hospital stay, reoperations and postoperative complications were included. Data were analyzed with SPSS 20. A total of 1237 patients were hospitalized and underwent rigid bronchoscopy. Forty-five (3.6%) patients with inedible foreign bodies in the airway were confirmed. There were no significant differences in sex, time of onset and length of hospital stay between the inedible and edible foreign body groups, except for age and a definite history of foreign body aspiration (P = 0.000). Coughing, wheezing and fever were the common clinical symptoms in all patients. The following were the common locations of inedible foreign bodies: right bronchus (22/45), left bronchus (18/45), trachea (3/45) and larynx (2/45). The most frequent inedible foreign bodies were parts of a pen (15/45), a light-emitting diode (7/45) and plastic parts of toys (6/45). Vocal cord injury and a laryngeal web were observed in one case each.ConclusionRigid bronchoscopy is the method of choice for the removal of inedible foreign bodies. Adequate preoperative assessment to rely on CT scans, skillful operation techniques to avoid damaging and active management of postoperative complications are important for the success of the procedure.

Awake intubation for thoracic aortic aneurysm causing esophageal stenosis with food residues and compression of the pulmonary artery and left bronchi: a case report

BackgroundAnesthetic management of thoracic aortic aneurysms (TAAs) is sometimes difficult due to fatal complications, including hypovolemic shock secondary to aneurysm rupture. We report the successful management of an impending rupture of a TAA with associated esophageal stenosis and compression of the pulmonary artery and left bronchi.Case presentationAn 83-year-old woman, diagnosed with an impending rupture of the ascending TAA, was scheduled to undergo emergency total aortic arch replacement. Computed tomography showed esophageal stenosis with significant amounts of food residues in the thoracic esophagus and compression of the pulmonary artery and bronchi. We performed awake intubation and superior laryngeal nerve block with light sedation to prevent aspiration and aneurysmal rupture, respectively. General anesthesia was induced immediately after the intubation. No intraoperative complications occurred.ConclusionsPerforming awake intubation with a superior laryngeal nerve block and sedation may prevent aspiration of food residues and hemodynamic changes that may lead to rupture.

Therapeutic bronchoscopy followed by sequential radiochemotherapy in the management of life-threatening tracheal adenoid cystic carcinoma: a case report

BackgroundAdenoid cystic carcinoma of the lung is a distinctive salivary-gland-type malignant epithelial neoplasm that rarely presents as a primary tumor of the respiratory tract. Complete surgical resection remains the treatment of choice for adenoid cystic carcinoma. We present a case of large ACC tumors that caused severe central airway obstruction and were effectively treated with therapeutic bronchoscopy followed by radiotherapy and chemotherapy.Case presentationA 31-year-old Malay Indonesian female patient who was a nonsmoker and had no family history of cancer was admitted to the emergency ward because of worsening breathlessness accompanied by stridor since 1 week prior. Chest computed tomography revealed segmental atelectasis of the left lung; a mass on the left main bronchus, with infiltrates in segments 1, 2, and 3 of the left lung; and consolidation in the left inferior lobe, with narrowing of the main left bronchus. Lobulated masses obstructing almost the entire distal trachea up to the carina and the entire left main bronchus were found on bronchoscopy. Owing to the large tumors causing severe central airway obstruction, the medical team decided to perform central airway mass removal through rigid bronchoscopy. A neodymium-doped yttrium-aluminum-garnet laser was used first to facilitate mass shrinkage. After the laser treatment, mechanical mass removal using a rigid scope was performed. The tracheal and carinal lumens were opened to > 50% of their diameter, with the left main bronchus lumen opened only slightly. After the treatment, the patient was stable, and no stridor was found. Adjuvant intensity-modulated radiotherapy and chemotherapy were performed after the therapeutic bronchoscopy. At the end of the entire treatment, reevaluation by thoracic computed tomography scan and bronchoscopy revealed no remaining mass.ConclusionsIn cases of nonresectable large adenoid cystic carcinoma tumors with life-threatening central airway obstruction, therapeutic bronchoscopy followed by sequential radiochemotherapy might achieve a complete response outcome.

Scimitar Syndrome in a Newborn

Introduction: Scimitar syndrome is a rare congenital condition that is usually presented in two major types, the infantile type as a severe condition with a poor outcome (median age: 2 months) and the adult type with a better condition and good outcome. It also has a wide spectrum of clinical presentations, from being asymptomatic in the adult type to cardiac and respiratory failure and pulmonary hypertension in the infantile type. Case Presentation: In this case report, we present a 43-day-old female case referred to Taleghani Children Hospital, Gorgan, Iran, with respiratory symptoms. In a physical examination, the case had a grade II/VI murmur, dextrocardia, and respiratory distress. In evaluations, the patient had severe stenosis proximal to the left common carotid artery after its origin. The heart and mediastinum were displaced to the right side, and the thoracic aorta was normal in size and orientation. bovine type of supra-aortic arch branches in the left-sided aortic arch, hypoplasia of the right upper lobe with severe hypoplasia of the right lower lobe were seen as well. There was sequestration adjacent to the right lower lobe with a dual feeder artery directly from the abdominal aorta and celiac branch and dual draining veins. Partial anomalous pulmonary venous connection was detected in the neck, and mediastinal computed tomography (CT) angiography with reconstructed views.. Bronchoscopy revealed right main bronchus hypoplasia and right lower lobe hypoplasia. Then, with the help of angiography, scimitar syndrome diagnosis was confirmed for the patient. Conclusions: Although scimitar syndrome is an uncommon condition, it has serious complications and poor outcomes in some patients. It is necessary to be aware of this rare congenital condition and use helpful methods, such as CT angiography and angiography, to confirm the diagnosis.

Fiberoptic Bronchoscopic Findings in Patients Suffering from Emerging Pulmonary Lophomoniasis: A First Registry-Based Clinical Study

Background Lophomonas blattarum is an emerging protozoan agent that mainly infects the lower respiratory system, causing pulmonary lophomoniasis. The bronchoscopic findings in patients with pulmonary lophomoniasis have not been investigated yet. Accordingly, we assess the bronchoscopic findings of lophomoniasis in patients suffering from pulmonary lophomoniasis through a registry-based clinical study. Methods In this retrospective study, of 480 patient candidates for bronchoscopy, 50 Lophomonas-positive patients were enrolled. Demographic data, relevant characteristics, and bronchoscopy findings of the patients were recorded and analyzed. Results Overall, 50 (male = 32, female = 18) patients with an average age of 61.8 ± 13.3 years were examined. Nineteen patients (38%) had normal bronchoscopic findings, and 31 patients (62%) had abnormal bronchoscopic findings. According to the severity index, most (52%) of patients had mild severity, followed by moderate (30%) and severe (18%) cases. The highest involvement was in the right lung bronchus (46%), and the lowest was in the carina (8%). Furthermore, purulent and mucosal secretions in the right and left lung bronchus were the most abnormalities found in different anatomical locations. Conclusion For the first time, the current study demonstrated that pulmonary lophomoniasis does not have pathognomonic bronchoscopic findings. However, each suspected patient must be checked for lophomoniasis, even with normal bronchoscopic findings, particularly in endemic areas.

An Unusual Case of Invasive Aspergillus Ulcerative Tracheobronchitis Without Involvement of Lung Parenchyma in a Post-Renal Transplant Patient

We present the case of a 54-year-old male, who presented with respiratory complaints four months after he underwent renal transplantation. Bronchoscopy showed ulcerated mucosa of the left main bronchus and computed tomography (CT) of the thorax showed foci of air within the bronchial wall. A biopsy from the lesion showed septate fungal hyphae, dichotomously branching at acute angles. A locally invasive Aspergillus ulcerative tracheobronchitis with no parenchymal involvement is an important cause of tracheobronchitis in post-renal transplant patients. An early diagnosis and institution of appropriate treatment can improve the outcome. A combination treatment of caspofungin and voriconazole can be considered if patient is not responding to voriconazole alone.

Bronchoscopic Management of Benign Bronchial Stenosis by Electrocautery and Balloon Dilatation

Benign bronchial stenosis is managed by surgical or bronchoscopic methods. Although surgical approach is definitive, it is technically demanding and is costlier than bronchoscopic treatment. Here, we report the case of a 27-year-old female patient with symptomatic benign bronchial stenosis of the left main bronchus. The stenosis was dilated successfully through a fibreoptic bronchoscope by electrocautery followed by balloon bronchoplasty and application of mitomycin-C. On follow up, there was no evidence of re-stenosis.

Ultrasound-Guided Selective Bronchial Intubation: A Feasibility Study in Pediatric Animal Model.

ObjectiveSelective one-lung ventilation used to optimize neonatal and pediatric surgical conditions is always a demanding task for anesthesiologists, especially during minimally invasive thoracoscopic surgery. This study aims to introduce an ultrasound-guided bronchial intubation and exclusion technique in a pediatric animal model.MethodsSeven rabbits were anesthetized and airway ultrasound acquisitions were done.ResultsTracheal tube progression along the trachea to the right bronchus and positioning of the bronchial blocker in the left bronchus were successfully done with consistent ultrasound identification of relevant anatomical structures.ConclusionThe study provided a new application of ultrasound in airway management. More advanced experimental studies are needed since this technique has the potential for translation to pediatric anesthesia.

Abstract CT113: A phase II study of prexasertib, a cell cycle checkpoint kinase 1 (CHK1) inhibitor, in platinum-resistant recurrent high-grade serous ovarian cancer (HGSOC) with BRCA wild-type (BRCAwt)

Abstract Background: Platinum-resistance is associated with a poor prognosis in HGSOC and has limited treatment options. Inhibition of CHK1 has shown activity in BRCAwt HGSOC. Here, we report the clinical activity and tolerability of the second generation CHK1 inhibitor, prexasertib, in platinum-resistant BRCAwt HGSOC (NCT02203513). Methods: Eligibility included platinum-resistant recurrent HGSOC women without germline or somatic BRCA mutation, ECOG PS 0-2, good end organ function, and measurable disease. The primary endpoint was response rate (RR). Secondary endpoints were progression-free survival (PFS) and safety. Prexasertib was given at 105 mg/m2 IV every 14 days in a 28-day cycle. CT scans were performed every 2 cycles for RECIST v1.1 evaluation, and safety evaluation using CTCAE v4.0 every cycle. CBC was performed on day 8 of cycle 1 for ANC nadir. Pretreatment clinical samples were collected for biomarker analysis including HR deficiency and circulating tumor cells (CTC). Results: Between January 2017 and November 2020, 49 patients (median age 64.1 years [IQR 56.8 - 69.9]) received at least one dose. 12 (24.5%) patients were primary platinum-resistant, and 37 (75.5%) were secondary platinum-resistant. All were heavily pretreated (median 4 prior systemic therapies [IQR 3 - 7]), including bevacizumab (79%), PARP inhibitors (44%), and both (2%). 39 patients were evaluable by RECIST and RR was 30.7%. The median PFS was 5.8 months (range 1.7-26.4 months). The median duration of response among PRs was 5.5 months (range 1-19.8 months). The clinical benefit rate (PR+CR+SD &amp;gt;4 months) was 84.6%. 10 patients were inevaluable due to: withdrawal of consent (n=2), intercurrent illness related to disease (tumor invasion of mainstem bronchus (n=1) or vaginal wall (n=1), small bowel obstruction (n=2), infection (n=2), failure to thrive (n=1), and pneumothorax secondary to thoracentesis (n=1) during cycle 1. The common (&amp;gt;10%) grade 3 or 4 adverse events (AEs) included neutropenia (85%, 42/49) based on the cycle 1 day 8 CBC at the time of ANC nadir, lymphocytopenia (46%, 23/49), thrombocytopenia (40%, 20/49), anemia (30%, 15/49), and febrile neutropenia (12%, 5/49). 83% (41/49) of patients received growth factors support to avoid subsequent treatment delays. There were no deaths on the study. No significant difference of RECIST response or PFS was observed in patients with high (≥2) vs low (&amp;lt;2) CTC at baseline. Conclusions: Prexasertib monotherapy resulted in clinical benefit in subgroups of heavily pretreated BRCAwt platinum-resistant HGSOC. Prexasertib was well tolerated with manageable grade 3/4 AEs. Further studies on predictive biomarkers are ongoing. Citation Format: Grant Zurcher, Ann McCoy, Brooke Solarz, Jay Nair, Min-Jung Lee, Jane B. Trepel, Christina M. Annunziata, Jung-Min Lee. A phase II study of prexasertib, a cell cycle checkpoint kinase 1 (CHK1) inhibitor, in platinum-resistant recurrent high-grade serous ovarian cancer (HGSOC) with BRCA wild-type (BRCAwt) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT113.

Strategy for lung parenchyma-sparing bronchial resection: a case series report.

Lung parenchyma-sparing bronchial resection is uncommon, and the operative procedure depends on the cause and location of the stenosis. We present 6 cases and discuss the different surgical strategies for sleeve resection of the central airway without lung resection. Bronchoplasty for the main bronchus and truncus intermedius was performed with a posterolateral approach. We resected the right main bronchus including the right lateral wall of the lower trachea and half of the carina obliquely and performed an anastomosis. The tumour in the left lobar bronchus was exposed and removed by transient division of the accompanying pulmonary artery. Although post-transplant stenosis and malacia can pose a challenge, bronchoplasty can be used as a definitive treatment in experienced centres.

Advanced age is not the decisive factor in chemotherapy of small cell lung cancer: a population-based study.

Objective: There is limited research on the impact of chemotherapy on the prognosis of different age group patients with small cell lung cancer (SCLC). The aim of this study was to explore the impact of chemotherapy on survival prognosis of elderly patients with SCLC.Methods: Based on the Surveillance, Epidemiology and End Results (SEER) database, 57,460 SCLC patients between 2004 and 2015 were identified and divided into a ≤ 80 years group (n = 50,941) and a >80 years group (n = 6,519). Confounding factors were controlled by propensity score matching (PSM) analysis. Kaplan Meier (KM) analysis was performed to determine the impact of chemotherapy on overall survival (OS) and lung-cancer specific survival (LCSS) of the patients. Other variables that could affect survival of SCLC patients were also examined by COX analysis.Results: KM analysis showed that both OS and LCSS were improved in chemotherapy group compared to those in non-chemotherapy group (log rank P < 0.001) in both age groups after PSM. Cox analysis demonstrated the survival benefit of chemotherapy in both ≤ 80 years group (OS: HR 0.435; 95% CI 0.424–0.447; LCSS: HR 0.436; 95% CI 0.424–0.448) and >80 years group (OS: HR 0.424; 95% CI 0.397–0.451; LCSS: HR 0.415; 95% CI 0.389–0.444). Additionally, the following parameters had a negative impact on survival of elderly patients: male sex, tumor location in main bronchus, increased stage, bilateral tumor, no surgery or radiation, and lower median household income.Conclusions: Elderly patients with SCLC should be encouraged to receive chemotherapy provided their general conditions permit.

RAPIDLY PROGRESSIVE POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER AFTER LUNG TRANSPLANTATION

TYPE: Case Report TOPIC: Transplantation INTRODUCTION: Posttransplant lymphoproliferative disorder (PTLD) after lung transplantation occurs due to immunosuppressant therapy, which limits antiviral host immunity and permits Epstein-Barr viral (EBV) replication and B cell transformation. CASE PRESENTATION: A 67-year-old female, bilateral lung transplant recipient (07/2019) with a history of idiopathic pulmonary fibrosis developed rapidly progressive PTLD in the early postoperative course. DISCUSSION: At 6-months after transplant, chest radiographs revealed left hilar fullness; subsequent chest CT showed evidence of fluid in the fissure, with no obvious lymphadenopathy. Chest CT performed just two weeks later revealed a left hilar mass measuring 6.1 × 2.7 cm with encasement of the left main pulmonary artery and partial collapse of the left main bronchus. Endobronchial ultrasound-guided biopsies led to the diagnosis of CD20-positive, EBV-positive PTLD. Initial PET scan demonstrated multiple hilar lymph nodes, the largest measuring 2.2 × 2.8 cm. Immunosuppression was reduced, and because the PTLD involved only one area in an EBV-mismatched bilateral lung transplant recipient, she qualified for single-agent rituximab once/week. Unfortunately, repeat imaging after five doses of rituximab demonstrated significant disease progression. She required repeat bronchoscopy with tumor debulking for a necrotic, endobronchial tumor occluding up to one-half of the left lower lobe bronchus. She started R-mini-CHOP, and after three cycles of chemotherapy, complete response was observed on the most recent PET/CT scan. CONCLUSIONS: PTLD may progress quickly, as the initial chest CT scan showing fluid collection advanced rapidly into a hilar mass. Reduction in immunosuppression, anti-CD20 biologic therapy, and chemotherapy for refractory PTLD remains an appropriate treatment paradigm. DISCLOSURE: Nothing to declare. KEYWORD: Post-lung transplant lymphoproliferative disorder

Systemic bevacizumab for aggressive recurrent respiratory papillomatosis: A single center experience of five cases.

e22005 Background: Recurrent respiratory papillomatosis (RRP) is a human papillomavirus (HPV) driven benign neoplasm, affecting larynx, trachea, and even lung, leading to voice disorders, airway obstruction, and post-obstructive pneumonia. Currently, there is no curative therapy for RRP.Patients require frequent debulking operations for symptomatic palliation. However, several case reports documented promising results on inhibition of vascular endothelial growth factor (VEGF) by systemic administration of bevacizumab. Methods: We retrospectively analyzed clinical, radiological, and bronchoscopy data of aggressive RRP patients treated with systemic bevacizumab since January 2021. Results: 5 consecutive patients were included. Median age (range) was 8 (4-30), 60% (3/5) were male. The locations of RRP were as follows: localized in the major airway (including vocal cords, larynx, trachea, and main bronchus), n = 1; extensive from major airway to lung parenchyma, n = 4. The median number (range) of local interventions was 8 (2-17) throughout the 12 months prior to bevacizumab treatment. The administration of systemic therapeutic agents, such as HPV vaccine and interferon had been tried in two patients. Bevacizumab was administered at a dose of 5 mg/kg (n = 4) or 7.5 mg/kg (n = 1) intravenously. Treatment intervals were initiated every 2-3 weeks and subsequently extended after achieving the maximum response. The patients received median 6 cycles of bevacizumab (range 4-7). The bevacizumab was given as adjuvant therapy in 2 patients on the 3rd and 5th day after laser operation, and as salvage therapy in the other 3 patients. All patients with major airway RRP displayed improvement in disease burden. No patients required surgery during a medain 7 (range 3-8) months follow up periods after initiating bevacizumab treatment. A rapid response was demonstrated in a patient with long-standing extensive pulmonary disease. Except from mild and transit abdominal pain and hemoptysis in 2 patients, systemic treatment with bevacizumab was well tolerated. Conclusions: Inhibition of VEGF by systemic bevacizumab seems to be a well tolerated and effective treatment option for localized and extensive forms of RRP.

UNILATERAL LUNG COLLAPSE: A RARE CAUSE

TYPE: Late Breaking Abstract TOPIC: Allergy and Airway INTRODUCTION: Allergic bronchopulmonary aspergillosis (ABPA) an allergic reaction to fungal antigens resulting in characteristic clinical and radiological mfeatures and is seen in patients asthma or cystic fibrosis. ABPA is characterised by uncontrolled asthma, wheezing, elevated agglutinins against aspergillus antigens,bilateral fleeting opacities on chest x-ray and central bronchiectasis..Immune response to Aspergillus antigens causes intense eosinophilic and neutrophilic inflammation and tenacious mucus secretions which can lead to airway obstruction and if untreated, bronchiectasis and pulmonary fibrosis CASE PRESENTATION: We report a middle aged lady who presented with a history of significant weight loss, chronic cough and breathing difficulty and was found to have complete left lung collapse with abrupt cut off left main bronchus on imaging. She was provisionally diagnosed as left lung collapse secondary to an endobronchial obstruction by a probable neoplastic lesion.Subsequent diagnosis of ABPA and conservative medical treatment led to complete resolution of the collapse over a period of 6 months. Serial chest x rays over 6 months DISCUSSION: Patients with ABPA can have diverse radiological manifestations. Although ABPA is usually a bilateral disease it is possible to have unilateral involvement which can in extreme instances lead to lung collapse . CONCLUSIONS: ABPA can rarely lead to unilateral lung collapse .When diagnosis is made early and treatment with steroid is initiated, irreversible lung damage can be prevented. Based on our case and similar reports we feel ABPA should be considered as a differential diagnosis whenever encountering a patient with total lung collapse and history of asthma. DISCLOSURE: I have been a member of the advisory board of M/s Cipla, M/s Glenmark pharmaceuticals, M/s Zydus cadila and am a member of the speakers bureau of M/s Astra Zeneca pharmaceuticals ( all of the above mentioned are pharmaceutical companies ) I hold shares o KEYWORD: ABPA

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series.

BackgroundAnastomosis management is the main challenge of airway resection and reconstruction, and postoperative anastomotic complications, including ischemia, stenosis, dehiscence, and separation may lead to severe outcomes and a poor prognosis. The anastomotic buttress is vital in airway reconstruction, but the selection of surgical buttress and reinforcement remains controversial. We aimed to demonstrate and evaluate the buttress options of anastomosis, including their preoperative characteristics, the intraoperative process, and the incidence of postoperative complications to help address the controversy regarding anastomosis management.MethodsThis retrospective study was conducted at a single institution. Patients who underwent airway reconstruction with anastomotic wrapping from Jan. 2019 to Sep. 2021 were enrolled in this study and preoperative characteristics and operational features were collected. All patients were carefully followed up by telephone and outpatient. Their postoperative complications and postoperative status after 6 months were recorded. The surgical procedures and clinical characteristics of the buttress options of anastomosis were assessed.ResultsA total of 62 patients undergoing either cervical tracheal, thoracic tracheal, carinal, or secondary carinal and main bronchus resection and reconstruction were evaluated. The anastomotic buttress used included mediastinal pleural flap (24/62, 38.7%), anterior cervical muscle (14/62, 22.6%), sternocleidomastoid (2/62, 3.2%), thymus flap (12/62, 19.4%), intercostal muscle flap (2/62, 3.2%), biological patch (2/62, 3.2%), prepericardial fat (1/62, 1.6%), thyroid gland (1/62, 1.6%), pectoralis major flap (2/62, 3.2%), and omental flap (2/62, 3.2%). All procedures produced satisfactory results without short-term anastomotic complications. A follow-up for 6 months was conducted and all patients were alive postoperatively. Tracheomalacia stenosis postoperatively occurred in 3 patients and they were subsequently treated with an endotracheal stent. One patient had tumor recurrence 3 months after surgery and received adjuvant chemotherapy.ConclusionsVarious anastomotic wrapping materials are used in airway reconstruction. Different utilizations of buttress are selected according to the anatomic characteristics and the reconstruction method used. This study indicated that appropriate surgical buttresses for wrapping anastomoses are legitimate alternatives to reduce the risk of anastomotic complications.