Tratamiento de la estenosis traqueobronquial con prótesis: factores de buena respuesta / Treatment of tracheobronchial stenosis with stents: good response factors

OBJETIVO: Determinar predictores de buena respuesta con el uso de prótesis en la estenosis traqueobronquial. MATERIALES Y MÉTODO: Estudio retrospectivo descriptivo de una serie de casos entre junio de 2014 y junio de 2016. Se revisaron registros clínicos, protocolos operatorios, estudios histopatológicos y de imagen. Se consignaron antecedentes demográficos y clínicos al ingreso y luego del procedimiento, etiología de la estenosis traqueal, necesidad de oxígeno en litros, estadía hospitalaria, morbilidad asociada al procedimiento, indicación de terapia complementaria posterior y sobrevida. Se analizaron los datos con estadística descriptiva y analítica. RESULTADOS: Se realizaron 68 procedimientos, en 44 pacientes, 24 mujeres, el diagnóstico principal fue estenosis traqueal con 40 casos. La etiología neoplásica fue el 88% de los casos. El Performance status (PS) de ingreso fue mayor o igual a 2 en el 68% y posterior al procedimiento disminuyó a 22% p < 0,05. En 36 casos los pacientes requerían al menos 1 L de oxígeno lo que disminuyó en 13 casos posterior a la intervención p < 0,05. El tiempo de hospitalización promedio fue 6,2 días (1-60). En 13 pacientes con patología neoplásica se indicó terapia paliativa complementaria. La morbilidad asociada al procedimiento fue de 2,9% dado por prótesis desplazada y lesión iatrogénica. La sobrevida fue de 27% a un año. CONCLUSIONES: La etiología benigna, el PS previo a la intervención menor o igual a 3, requerimiento de oxígeno de 1 litro y obstrucción tumoral menor al 70% del lumen fueron elementos de buena respuesta.

AIM: Determine good response predictors in use of stent in benign and malignant tracheobronchial stenosis. MATERIAL AND METHODS: We retrospectively reviewed medical records of patients submitted to the procedure in the period 2014 to 2016. Clinical records, operative protocols, and histopathological and imaging studies were reviewed. Demographic and clinical data, performance status (PS) at admission and after the procedure, etiology of tracheal stenosis, need for oxygen in liters (L) Post-intervention, hospital stay, procedure-related morbidity, indication of therapy (Chemotherapy and/or Radiotherapy) and survival. Data were analyzed with descriptive and analytics statistics. RESULTS: A total of 68 procedures were performed in 44 patients, 24 women. Tracheal stenosis 40 cases were diagnosed. The malignant etiology was 88%. The admission PS was greater than or equal to 2 in 68% and 22% after the procedure. The oxygen requirements prior to the procedure were at least 1 L in 36 cases and decreased in 13 cases after the procedure. The average hospitalization period was 6.2 days (1-60). Complementary therapy was indicated in 13 patients; the morbidity associated with the procedure was 2.9%, displaced installation and iatrogenic injury. The one year survival was 27%. CONCLUSIONS: Benign etiology, el PS minor than or equal to 3, oxygen requirements prior to the procedure of 1 L and tumoral obstruction less than 75% were good response predictors in our study.

Severe tracheobronchial compression in a patient with Turner's syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives.

We present a case of severe tracheobronchial compression from a complex aorto‑subclavian aneurysm in a patient with Turner’s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

Utiity of tests used to diagnose asthma, gastroesophageal reflux and upper airway cough syndrome in patients with chronic cough and normal chest radiography

Despite the clinical significance of cough, research efforts aimed at improving diagnostic capabilities and developing more effective therapeutic agents have been, to date, disappointing in their limited scope and outcomes. Asthma, gastro-oesophageal reflux disease [GERD] and upper airway cough syndrome [UACS] are common causes for chronic cough with a normal chest X-ray [CXR]. To describe the frequency of these three causes in a cohort of outpatients with chronic cough and normal CXR and to identify the diagnostic tests best able to identify the aetiology in the vast majority of cases using the response to specific therapy as a gold standard. Nonsmoking outpatients of both genders who complained of cough for more than 8 weeks and had normal findings on CXR were studied prospectively. All patients were subjected to spirometery [including postbronchodilator reversibility], sinuses CT scan, rhinoscopy, and 24-h esophageal pH monitoring to get "an initial diagnosis". The assumed causes were confirmed by treating them sequentially. "The final diagnosis" depended on a successful response to therapy. Hundred patients were studied: the laboratory tests established initial diagnoses of asthma, UACS, GERD, or various combinations of these in 78 patients, of those; 35 patients [44.9%] had a single cause, 39 patients [50%] had two causes, and 4 patients [5.1%] had all three causes. After treatment of those 78 patients, the final diagnoses were established as follow: 47 patients [60.3%] has a single cause, 28 patients [35.9%] had two causes and 3 patients [3.8%] had all three causes. There was a good agreement between the laboratory tests and the definite causes [agreement in 65 patients [83%] and discrepancy in 13 patients [17%], k > 0.75]. Twelve patients had their diagnoses changed for two causes to a single cause and one patients had the diagnosis changed from three causes to two causes. Asthma, UACS, GERD, or some combination of these represent 78% of the causes of chronic cough in our sample. Therefore, these conditions should be considered first during diagnostic evaluation of patients with chronic cough and normal CXR. Inspite of some discrepancy between initial and final diagnoses, the study identifies the group of diagnostic methods best able to identify the cause in the vast majority of cases of chronic cough including sinuses CT scan, rhinoscopy, pulmonary function tests, and esophageal pH monitoring

Benign superior mediastinal syndrome due to intrathoracic tuberculosis in a child-association with endobronchial tuberculosis.

A 5-year-old boy presented with fever, cough, breathlessness and facial swelling. He was pale with distended veins over neck and chest, cervical and axillary lymphadenopathy and bilateral expiratory wheeze. Chest radiographs showed superior mediastinal widening. A computed tomography scan of the chest revealed mediastinal lymph nodes compressing superior vena cava and trachea. Bronchoscopy revealed nodular lesions in trachea and bronchi and compression of trachea. Broncho-alveolar lavage revealed acid fast bacilli. Diagnosis of superior mediastinal syndrome (SMS) secondary to tuberculosis was made and child was treated with antitubercular treatment along with oral prednisolone with good response.

Traqueobroncopatía osteocondroplástica: reporte de un caso y revisión de la literatura / Tracheobronchopathy osteochondroplastica: a case report and literature review

La traqueobroncopatía osteocondroplástica es una enfermedad benigna poco frecuente, de etiología incierta, caracterizada por múltiples nodulos submucosos cartilaginosos u óseos en tráquea, bronquios principales y menos frecuentemente, región subglótica y laringe. La presentación clínica de la enfermedad varía desde pacientes asintomáticos, hasta enfermedad severa con obstrucción de la vía aérea. El gold standard para el diagnóstico es la broncoscopía, donde característicamente se visualiza la presencia de múltiples nodulos submucosos que se proyectan hacia el lumen de la vía aérea. La biopsia no es requisito para el diagnóstico. El tratamiento de la enfermedad está dirigido habitualmente al manejo sintomático. En pacientes con severa obstrucción de la vía aérea se han realizado terapias broncoscópicas como ablación con láser, crioterapia o divulsión mecánica de las lesiones. También se ha intentado la resolución quirúrgica, siendo generalmente inefectiva. Presentamos el caso clínico de un paciente evaluado en nuestro servicio, en quien se realizó diagnóstico de traqueobroncopatía osteocondroplástica con compromiso tráqueo-bronquial y subglótico.

Tracheobronchopathy osteochondroplastica is a rare benign disease of uncertain etiology characterized by múltiple cartilaginous or bony submucosal nodules in trachea, bronchi and, less frequently subglottic región and larynx. The clinical presentation of the disease varíes from asymptomatic patients to severe disease with airway obstruction. The gold standard for diagnosis is bronchoscopy, which typically displays the presence of múltiple submucosal nodules that project into the lumen of the airway. Biopsy is not required for diagnosis. The treatment of the disease is usually symptomatic management. In patients with severe airway obstruction bronchoscopic therapies such as laser ablation, cryotherapy or mechanical removal have been performed. Surgical resolution has also been attempted, being generally ineffective. We report the case of a patient evaluated in our department, in whom the diagnosis of tracheobronchopathy osteochondroplastica with tracheobronchial and subglottic compromise was made.

Unusual Combination of Tracheobronchopathia Osteochondroplastica and AA Amyloidosis

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause characterized by the presence of multiple submucosal osseous and/or cartilaginous nodules that protrude into the lumen of the trachea and large bronchi. A simultaneous diagnosis of TO and amyloidosis is rarely reported. In this report, a case initially suspected to be asthma bronchiole that could not be treated, was radiologically diagnosed as TO, and also secondary amyloidosis is presented. A 53 years, man patient reported a 3 years history of dyspnea. Pulmonary function tests (PFTs) showed an obstructive pattern. Chest X-rays revealed right middle lobe atelectasis. FOB and CT detected nodular lesions in the trachea and in the anterior and lateral walls of the main bronchi. AA amyloidosis was confirmed by endobronchial biopsy. In the abdominal fat pad biopsy, amyloidosis was not detected. Asthma bronchiole was excluded by PFTs. This case illustrates that it is possible for TO and amyloidosis to masquerade as asthma. TO and amyloidosis should be suspected in patients of older ages with asthma and especially with poorly treated asthmatic patients. Although nodular lesions in the anterior and lateral tracheobronchial walls are typical for TO, a biopsy should be obtained to exclude amyloidosis.

Allergic Bronchopulmonary Aspergillosis Coupled with Broncholithiasis in a Non-asthmatic Patient

Allergic bronchopulmonary aspergillosis (ABPA), an asthmatic disease, is caused primarily by hypersensitivity to Aspergillus species. ABPA is rarely observed in the absence of asthma, which is, in fact, the principle criterion for its diagnosis. Here, we report the case of a 36-yr-old woman without a history of bronchial asthma, who manifested a localized pneumonic consolidation, coupled with broncholithiasis. Pathologic examinations of bronchoscopic biopsy specimens and resected surgical specimens revealed features typical of ABPA. This is a very rare case of ABPA coupled with broncholithiasis in a non-asthmatic individual.

Mycobacterium Avium Complex Infection Presenting as an Endobronchial Mass in a Patient with Acquired Immune Deficiency Syndrome

Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with AIDS (acquired immune deficiency syndrome). Pulmonary involvement of MAC may range from asymptomatic colonization of the respiratory tract to invasive parenchymal or cavitary disease. However, endobronchial lesions with MAC infection are rare in immunocompetent and immunosuppressed hosts. Here, we report MAC infection presenting as an endobronchial mass in a patient with AIDS.

Tracheobronchial amyloidosis: a report of two cases.

We describe here two patients with tracheobronchial involvement by amyloidosis. One of them had presented with discrete tracheobronchial mass lesions simulating bronchogenic carcinoma. The other had intermittent streaky hemoptysis and was found to have diffuse tracheobronchial involvement at bronchoscopy. Both patients are doing well without any definitive therapy.

Atelectasis in children.

BACKGROUND: In children with lower respiratory tract symptoms, the elicited signs are not enough to distinguish common diagnosis like pneumonic consolidation, foreign body aspiration and atelectasis. Radiology and bronchoscopy would identify the true nature of the etiology. DESIGN: Prospective study. SUBJECTS: Thirty five children with both acute and chronic lower respiratory tract symptomatology, were analyzed for clinical and radiological signs of atelectasis. RESULTS: There were 23 cases in the acute group and 12 in chronic group. Acute group included cases of pneumonia, foreign body aspiration and mucus plug syndrome. Chronic group included cases of congenital heart disease, endobronchial tuberculosis and bronchial stenosis. Clinical recognition of atelectasis on the basis of localized loss of breath sounds and mediastinal shift was seen only in a minority of cases (8/35). The presence of atelectasis in children with pneumonia, missed clinically were diagnosed by the presence of tracheal shift, elevated hemidiaphragm and silhouette sign. In 21 cases, silhouette sign was positive making it an important radiological sign. Twenty one children underwent either diagnostic or/and therapeutic bronchoscopy. Findings included foreign bodies (n = 5), mucus plugs (n = 4), narrowing of main bronchus (n = 4) and inflammatory mucoid secretions and narrowing of lumen (n = 8). There were no major complications. CONCLUSION: The diagnosis of atelectasis in children may pose difficulties and there is a need to have a high index of suspicion to exclude atelectasis in children with either acute or chronic respiratory tract symptomatology.

Congenital bronchoesophageal fistula associated with esophageal diverticulum in the adult

Congenital bronchoesophageal fistula is a rare clinical entity in adults. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking, and even hemoptysis. The fistula can cause symptoms in childhood but may not appear until adulthood. We recently experienced a case of congenital bronchoesophageal fistula associated with esophageal diverticulum in an adult. A 63-year-old woman was admitted to our hospital due to chest discomfort, sore throat and coughing bouts when eating. An empyema with lung abscess had occurred eight years previously. Results of the physical examination were unremarkable. A Barium swallowing revealed a medium-sized diverticulum at the right anterior aspect of the esophagus, which had developed a fistulous connection with the right lower lobe bronchus. The patient was treated by fistulectomy and lobectomy of the right lower lobe. The postoperative course was smooth and uneventful.

Une cause rare d'hemoptysie: broncholithiase: revue generale Apropos de 3 cas cliniques

The authors reported 3 cases of broncholithiasis revealed by hemoptysis. The diagnosis was confirmed at the endoscopy in two cases and by thoracotomy in the last case. The etiopathogenic, clinical and therapeutic characteristics was studied with literature review

Broncolitiasis: una causa de hemoptisis masiva / Broncholithiasis: a cause of massive hemopthysis

Se presenta el caso de una mujer de 50 años con antecedentes de tabaquismo y de contacto TBC, quien consultó en reiteradas ocasiones por episodios de hemoptisis entre los años 1982 a 1985, algunos de los cuales fueron de tal magnitud que produjeron una anemización de la paciente. El estudio etiológico de la hemoptisis concluyó en que se debía a una broncolitiasis en el bronquio segmentario apical del lobar inferior derecho. La paciente rechazó la intervención quirúrgica a pesar de la progresiva gravedad de los episodios de hemoptisis. No obstante, en julio de 1985 una nueva hemoptisis, esta vez de carácter masivo, le provocó una insuficiencia respiratoria grave, por lo que aceptó la intervención quirúrgica. Se efectuó una lobectomía inferior derecha sin incidentes. Posteriormente la paciente ha permanecido en control en el policlínico sin consignarse nuevos episodios de hemoptisis. Se presenta el caso clínico con sus hallazgos anatomopatológicos y se hace una breve revisión del tema