Lung transplantation after paraquat poisoning in an adolescent: one case report and literature review / 器官移植

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

Diagnosis and treatment progress on airway anastomotic stenosis after lung transplantation / 器官移植

Lung transplantation is the only effective treatment of most end-stage lung diseases. Airway anastomotic complications are the main obstacles affecting the postoperative survival and quality of life of lung transplant recipients. Airway anastomotic stenosis is the most common airway anastomotic complication after lung transplantation. In recent years, improvements in the recipient selection, organ preservation, surgical techniques, postoperative intensive care management, immunosuppression, antifungal and endoscopic treatment have decreased the incidence of airway anastomotic stenosis and improved the surgical efficacy of lung transplantation and the survival of the recipients. In this article, the pathogenesis, risk factors, diagnosis and treatment of airway anastomotic stenosis after lung transplantation were reviewed, aiming to provide novel ideas for clinical research, diagnosis and treatment of airway anastomotic stenosis following lung transplantation.

Nueva prótesis traqueobronquial metálica autoexpandible. Indicaciones y técnica: A propósito de nuestra experiencia en tres casos / New self-expanding metal tracheobronchial prothesis. Indications and technique. Our experience in tree cases

Si bien hasta el momento los stents más utilizados en vía aérea son los de silicona, desde hace un tiempo se utilizan los stents metálicos. Su indicación principal es la estenosis neoplásica maligna traqueal o bronquial. Hemos tenido la oportunidad de colocar un nuevo tipo de SMA en dos indicaciones distintas a la mencionada, por lo que nos parece interesante la descripción de los casos.

Although the most commonly used stents in the air are silicone, stents have been used for some time. Its main indication is malignant tracheal or bronchial neoplastic stenosis. We have had the opportunity to place a new type of SMA in two different indications to the mentioned one, reason why we consider interesting the description of the cases.

Veinte años de experiencia en trasplante pulmonar: Complicaciones de la vía aérea: Rol de la tomografía computada multidetector / Twenty-Year Experience in Lung Transplantation: Complications of the Airways. The Role of Multidetector Computed Tomography

Introducción: Las complicaciones de la vía aérea (CVA) en pacientes trasplantados pulmonares ocupan una causa importante de morbimortalidad; llegan a presentarse (hasta en el 18% de los mismos). Se incluyen la dehiscencia, la estenosis y la malasia. Objetivo: Demostrar nuestra experiencia en pacientes con CVA sometidos a trasplante pulmonar. Objetivo secundario: Demostrar la utilidad de la tomografía computada multidetector (TCMD) para el diagnóstico y control post tratamiento de las CVA. Materiales y métodos: Se analizaron las historias clínicas de pacientes trasplantados pulmonares con diagnóstico broncográfico de CVA. Además se compararon los hallazgos tomográficos de estos pacientes con el de las FBC. Resultados: De 325 trasplantes realizados en 20 años, 65 (20%) de ellos presentaron alguna CVA. Se reportó estenosis en 51 pacientes (78,5%); malasia en un 15% y dehiscencia en un 13,5%. Los pacientes con estenosis o malasia recibieron dilatación endoscópica; 33 de ellos presentaron re estenosis, por lo que a 30 se les implantó un stent. Las dehiscencias fueron tratadas con corrección quirúrgica, stents o cierre con Histoacryl. De los 30 pacientes con sospecha de CVA a los que se les realizó TCMD, esta demostró ser diagnóstica en el 100% de los casos. Conclusión: Las CVA deben sospecharse en caso de disnea, fiebre o empeoramiento de la clase funcional con caída del volumen espiratorio forzado en 1 segundo (VEF1). La TCMD con reconstrucciones multiplanares o 3D demostró alta certeza para el diagnóstico de las CVA, planeamiento de su terapéutica y control posterior de la misma.

Introduction: The complications of airways in lung transplant recipients are an important cause of morbidity and mortality, reaching up to 18% of patients according to various reports. Dehiscence, stenosis and malacia are included. Objective: Describe our experience in patients with complications of airways after lung transplantation. Secondary Objective: Demonstrate the usefulness of multidetector computed tomography for the diagnosis, treatment and monitoring of airways complications in lungs transplanted patients. Materials and Methods: The medical records of lungs transplanted patients with bronchographic diagnosis of the airways complications were reviewed and analyzed. Furthermore CT findings of these patients were compared with the bronchoscopy diagnosis to determine their utility. Results: Among 325 lung transplants performed in 20 years, 65 (20%) showed airways complications. The most frequently reported complications were stenosis in 51 patients (78.5%), malacia (15%) and dehiscence (13.5%). All patients with stenosis or malacia received first a therapeutic endoscopic dilatation; 33 of them had re-stenosis and in 30 patients a stent was implanted. Dehiscences were treated with surgical intervention, stenting or closing with Histoacryl. In 30 patients with clinical suspicion of significant airways complications, MDCT proved to be diagnostic in 100% of cases. Conclusion: The airways complications should always be suspected in cases of dyspnea, fever or worsening functional class associated with spirometry forced expiratory volume decline in one second. Also, MDCT with multiplanar and 3D reconstructions showed high accuracy for diagnosis, therapy planning and subsequent control.

Mass-forming Eosinophilic Infiltration Involving the Central Airway: A Case Report of Endobronchial Involvement of Eosinophilic Inflammation Mimicking Bronchogenic Malignancy / 대한내과학회지

We report a very unusual case of endobronchial involvement of eosinophilic inflammation. A 58-year-old woman visited our clinic complaining of cough. A chest computed tomography scan showed a poorly enhancing mass compressing both main bronchi in the subcarinal area. Bronchoscopy also showed stenosis of the two main bronchi with irregular mucosal thickening. A bronchoscopic endobronchial mucosal biopsy revealed eosinophilic inflammation without evidence of malignancy. The subcarinal mass disappeared after systemic steroid treatment. This is the first report of mass-forming eosinophilic infiltration involving the central airway mimicking primary lung cancer.

Frecuencia de lesión de la vía aérea identificada por broncoscopia en recién nacidos con intubación endotraqueal prolongada en una unidad de cuidados intensivos neonatales de tercer nivel / Frequency and type of airway injury identified by bronchoscopic examination in newborns with prolonged endotracheal intubation in a neonatal intensive care unit

Introducción. La intubación endotraqueal y la ventilación mecánica son recursos que se utilizan frecuentemente en la Unidad de Cuidados Intensivos Neonatales. Sin embargo, se ha observado que elevan significativamente la mortalidad, dado que se presentan complicaciones. Por tanto, el objetivo de este trabajo fue reportar la frecuencia y el tipo de lesiones de la vía aérea en recién nacidos con intubación endotraqueal prolongada a quienes se les realizó broncoscopia. Métodos. Se incluyeron 150 recién nacidos con tiempo de intubación endotraqueal ≥ 5 días a quienes se les realizó broncoscopia. Se registraron las siguientes variables: edad gestacional, peso al nacer, indicación de la intubación, tamaño del tubo endotraqueal, número de reintubaciones, tiempo de intubación, indicación de la broncoscopia, hallazgos de la broncoscopia, tipo de tratamiento y número de broncoscopias. Resultados. La principal indicación de la broncoscopia fue la atelectasia persistente o recidivante. Del total de los pacientes, 96% presentaron alguna alteración de la vía aérea. Predominaron las lesiones inflamatorias (67.3%), seguidas de malacia (39.3%) y estenosis (28.7%). Las estructuras anatómicas más afectadas fueron los bronquios (31.6%), la laringe (24%) y la tráquea (22%). En 126 pacientes se indicó tratamiento médico; los esteroides se utilizaron con mayor frecuencia. Además del tratamiento médico, a 21 pacientes (14%) se les realizó dilatación bajo broncoscopia y a 7 (4.6%), traqueostomía. Conclusiones. Las lesiones más frecuentes fueron de tipo inflamatorio. La atelectasia persistente fue la principal manifestación clínica, por lo que se sugiere considerarla para que, durante la exploración broncoscópica, se descarte lesión de la vía aérea en recién nacidos con intubación endotraqueal prolongada.

Background. Endotracheal intubation and mechanical ventilation are frequently use resources in the Neonatal Intensive Care Unit. Higher mortality has been observed as a result of complications. We undertook this study to report the frequency and type of airway injury in newborns with prolonged endotracheal intubation who underwent bronchoscopy examination. methods. Newborns (n = 150) who were intubated endotracheally for ≥ 5 consecutive days and who underwent bronchoscopy were included. We recorded the following variables: gestational age, birth weight, indications for intubation, size of endotracheal tube, number of reintubations, intubation length, indication for bronchoscopy, bronchoscopic findings, type of treatment for airway injury, and number of bronchoscopies. Results. The main indication for bronchoscopy was atelectasis (persistent and/or recurrent); 96% of newborns had at least one injury. The most frequent were inflammatory type (67.3%), malacia (39.3%), and stenosis (28.7%). The most injured anatomic structures were the bronchi (31.6%), larynx (24%), and trachea (22%). For 126 patients, primary medical treatment was steroids. For 21 patients (14%), dilatation was performed under bronchoscopy; and for 7 (4.6%) patients, tracheostomy was performed. Conclusions. The most frequent injuries were inflammatory-type. Persistent atelectasis was the principal clinical manifestation; therefore, it should be considered as an indication of bronchoscopic exploration to identify airway injury in newborns with prolonged endotracheal intubation.

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.

Effectiveness and safety of high frequency electronic associating stents insertion and subsequent radiotherapy guided by fiberoptic bronchoscope in treating malignant tracheobronchial stenosis / 中国医师进修杂志

ObjectiveTo evaluate the effectiveness and safety of high frequency electronic associating stents insertion and subsequent radiotherapy guided by fiberoptic bronchoscope in treating tracheobronchial stenosis caused by lung and esophagus carcinoma.MethodsFifty-two patients which were ascertained with serious stenosis in trachea or bronchi by fiberoptic bronchoscope were subjected to the study.Fiberoptic bronchoscope was used to investigate the location,extent,blood supply and the degree of tracheobronchial stenosis before the study.After the focus in the airways was cleared up with high frequency electronic,electrocoagulation and snare under the guide of the euthyphoria of fiberoptic bronchoscope,Ni-Ti memory alloy stents were placed into the stenosis airways.The 52 patients were divided into two groups with 26 cases each:the stent group and the stent associating radiotherapy group(radiotherapy group).The later group accepted subsequent radiotherapy after the therapy.The following indexes of the two groups were investigated:short-time clinical effect,dyspnea index class,rate and average time of airway restenosis,life span and survival rate.ResultsAfter therapy,the 52 patients had obvious improvements in dyspnea and the diameter of the stenosis airways.The short-time total effective rate was 100.0％ (52/52),but there was not significant difference between the two groups(P＞ 0.05 ).After therapy,there was significant difference in two groups in dyspnea index class(P ＜ 0.01 ).Although there was not significant difference in the rate of airway restenosis between the two groups(P＞0.05),the average time of airway restenosis in the radiotherapy group was obviously longer than that in the stent group(P＜ 0.01 ).The survival rate of the radiotherapy group in the 6th and 9th month after therapy was higher than that in the stent group (P ＜ 0.05),but there was no significantdifferenee in the 3rd and 12th month (P ＞0.05).ConclusionHigh frequency electronic associating stents insertion and subsequent radiotherapy guided by fiberoptic bronchoscope is an effective and safe treatment for the patients suffering tracheobronchial stenosis caused by lung and esophagus carcinoma.

Reconstruction of Tracheobronchial Stenosis due to Endobronchial Tuberculosis : A case report / 대한흉부외과학회지

A 20 year old woman had developed stenosis at the lower part of the trachea, right main bronchus, and right upper lobe bronchus as a complication of endobronchial tuberculosis. The patient had complained of severe dyspnea. Tracheobronchial stenosis was so extensive that we did reconstruction of the trachea and right bronchus with resection of the lower trachea and right main bronchus and right upper lobectomy. She has been doing well without any respiratory symptoms or complications.

Clinical Appilication of Endobornchial Cryoablation That's Performed through Flexible Bronchoscope for Treating Tracheobronchial Ostruction / 대한흉부외과학회지

BACKGROUND: Emergency airway access is essential when a patient has dyspnea that's due to tracheal or bronchial obstruction. Such methods as laser therapy and PDT are now being used for the treatment of tracheal obstruction that's due to benign diseases or nonsurgical malignant diseases. Cryotherapy is a method that uses extreme hypothermia for freezing a tumor to cause necrosis. In this study, we have evaluated the clinical effectiveness of performing endobronchial cryoablation through a flexible bronchoscope. MATERIAL AND METHOD: 10 patients with tracheal obstruction that was due to endotracheal tumors were evaluated between May 2005 and May 2007. Eight were male and the mean age of the 10 patients was 59.4+/-18.4 years. Three cases of tracheal obstruction were due to benign tumors and 7 were due to malignant tumors. The obstruction sites were 3 at the trachea, 3 at the carina and 4 at the bronchus. A flexible bronchoscope was inserted and the tumor was eliminated using a flexible cryoprobe. Follow up bronchoscopy was performed at 1 week and 1 month after cryoablation, and then we evaluated the decrease of dyspnea, the improvement of the performance and the complications of the procedures. RESULT: Complete remission was achieved in 4 patients and partial remission was achieved in 6 patients. Complications such as hemoptysis (100%), and cough (50%) were noted. Hemoptysis was spontaneously resolved in 3 to 8 days (mean: 4.9 days). A decrease in dyspnea and improvement in the performance was noted in all patients. CONCLUSION: Endobronchial stenosis plays a detrimental role in the life quality of a terminal cancer patient. Due to its simplicity and effectiveness for controlling bleeding, endobronchial cryoablation is considered to be a safe method that is clinically applicable to a wide range of tumors, including the removal of large tumors. We concluded that endobronchial cryoablation through a flexible bronchoscope is a safe, effective method for treating tracheobroncheal obstructions.

Correlación de la broncoscopía virtual y la fibrobroncoscopía en estenosis no neoplásicas de vías aéreas principales / Correlation between virtual bronchoscopy and fiberoptic bronchoscopy in non-neoplasic stenosis of the larger airways

Introducción: La exploración del árbol traqueobronquial puede hacerse directamente por fibrobroncoscopía (FB) y por imagen, broncoscopía virtual (BV), y por tomografía helicoidal computada en tercera dimensión (HCT3D). Objetivos: Evaluar diferencias entre la BVHCT3D y la FB en estenosis no neoplásicas de las vías aéreas principales. Material y métodos: Dieciseis casos de estenosis de vía aérea, 6 mujeres, 10 hombres de 16 a 57, promedio 33 años, evolución promedio 8 meses, rango de 2 a 108 meses. Diez con traqueostomía. En todos: FB con fibrobroncoscopio (FFB) y video para fotografía, HCT3D con reconstrucciones volumétricas y BV. Se determinaron sensibilidad (S) y especificidad (E) y significancia por r de Pearson para grado de estenosis y longitud de la vía aérea afectada por BVHCT3 y FB. Resultados: Siete estenosis subglótica, 4 estenosis traqueal, 1 estenosis de bronquio principal izquierdo, 2 colapso de tráquea y 2 granulomas. Se trataron 7 con técnica de Gríllo Pearson, 4 por anastomosis traqueales y 1 anastomosis bronquial terminoterminales, 1 terapia con láser, 1 dilatación y 2 no quirúrgicos. Para detección de estenosis, FB y BVHCT3D S 100% y E 100%. Para grado de estenosis, FB S 100% y E 100%, HCT3D S 60% y E 60%. Para extensión de estenosis FB detectó 4 casos, en 12 no pasó el FFB. En 12 casos operados, por HCT3D la correlación de la extensión fue exacta en 7 y en 5 error promedio de 10%. La extensión de la estenosis por HCT3D y en la pieza resecada por r de Pearson p< 0.05 -r=0. 7782 y grado estenosis p< 0.01 -r = 0.9534. Las 12 piezas resecadas tenían fibrosis, inflamación crónica, metaplasia epidermoide y granulomas en grado variable. Comentario y conclusiones: La BVHCT3D detecta grado de estenosis y extensión. La FB diagnostica estenosis y permanece como estándar de oro. Cuando el FFB no pasa es imposible medir longitud de la estenosis. La BVHC3D detecta espacialmente la estenosis de la vía aérea, no es invasiva y es costosa. ...

Introduction: Imaging of the larger airways can be done by fiberoptic bronchoscopy (FOB) or by virtual bronchoscopy by means of three dimensional helical computed tomography (VBHCT3D). Objectives: To compare the differences of both methods for the assessment of non neoplastic stenosis of the trachea and main bronchi, as diagnostic tools helpful in the planning of treatment in such cases. Material and methods: Sixteen cases, 6 women and 10 men, ages 16 to 57, mean 33 years; clinical course 2 to 108 months, mean 8 months. In all: FOB and VBHCT3D. Sensitivity (Se) and Specificity (Sp) were determined and statistical significance for both methods and Pearson's r for length and degree of the stenotic segment using VBHCT3D. Results: Location: 7 cases with subglotic and 4 with tracheal stenosis, 2 cases tracheal collapse, 1 case stenosis of the left main bronchus, 2 granulomas of the trachea. Etiology: 7 cases post tracheal intubation, 5 cases post traumatic, 1 post tracheostomy, 2 tracheomalacia, 1 granulomatous disease. Treatment: 7 Grillo Pearson's technique, five resection of the large airways and terminoterminal anastomosis, 1 dilatation, 1 laser therapy, 2 non-surgical. For the detection of stenosis, FOB and VBHCT3D had 100% Se and Sp; for the degree of stenosis. FOB had 100% Sp and Se, VBHCT3D had 60% Se and Sp. To evaluate the length of stenosis, FOB could not pass the obstruction in 12 cases. In the 12 surgical cases, for VBHCT3D there was exact correlation in 7 and a 10% mean error in 5 cases. For the length of the stenosis in the freshly resected specimen, Pearson's r by VBHCT3D p< 0.05 -r=0.7782, degree of stenosis p< 0.01 -r=0.9534. All 12 resected specimens showed various degrees of fibrosis, chronic inflammation, epidermoid metaplasia and granulomas. Conclusions: VBHCT3D can detect degree and length of stenosis, but the gold standard for stenosis and degree is FOB, but in severe cases the instrument can not pass the obstruction and assess its length. VBHCT3D detects degree and length of stenosis non invasively and is expensive. FOB visualizes stenosis and its degree with precision, is less expensive. Both methods are helpful in the diagnosis of degree and lenght of the obstruction and in the planning of surgical treatment.

Reconstruction of Mainstem Bronchus Obstructed by Endobronchial Tuberculosis / 대한흉부외과학회지

BACKGROUND: Non-invasive interventional therapy has been performed for main bronchial obstruction by endobronchial tuberculosis because of the risk of main bronchial reconstruction regardless of the pulmonary function. But, effects of the interventional therapy are attacked by arguments. This study was aimed at interpreting the risk and effectiveness of bronchoplasty for benign bronchial stenosis over the last ten years in our hospital by reviewing the results based on clinical progression. MATERIAL AND METHOD: We retrospectively reviewed the clinical records and out-patient medical records including 21 consecutive patients who underwent main bronchial reconstruction for obstruction by endobronchial tuberculosis. All of them had past medical history of anti-tuberculosis medication. They were preoperatively evaluated by bronchoscopy and chest computed tomography. RESULT: There were no incidences of postoperative mortality and significant morbidity. There were 2 cases of retained secretions but these problems were resolved by therapeutic bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. CONCLUSION: Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.

Clinical Features of Simple Bronchial Anthracofibrosis which is not Associated with Tuberculosis / 결핵

BACKGROUND: Bronchial anthracofibrosis (BAF) is a dark black or brown pigmentation of multiple large bronchi associated with a fibrotic stenosis or obliteration that is incidentally found during a diagnostic bronchoscopy. Some reporters have suggested endobronchial tuberculosis or tuberculous lymphadenitis as a possible cause of BAF. However, some BAF patients do not have any medical history of tuberculosis. The aim of this study was to elucidate the clinical features of simple BAF patients, which were not associated with tuberculosis. METHODS: We reviewed the patients' charts retrospectively and interviewed all BAF patients who were followed up for 1 year or more. Among the 114 BAF patients, 43 patents (38 %) had no associated tuberculosis, cancer and pneumoconiosis. The clinical characteristics, radiological findings and associated pulmonary diseases of these patients were evaluated. RESULTS: Most patients were non-smokers, old aged, housewifes who resided in a farming village. The common respiratory symptoms were dyspnea, cough and hemoptysis. The predominant X-ray findings were a multiple bronchial wall thickening(89%), bronchial narrowing or atelectasis (76%) and a mediastinal lymph node enlargement with/without calcification (78%). Pulmonary function test usually showed mild obstructive ventilatory abnormalities but no patient showed a restrictive ventilatory pattern and the patients were frequently affected with chronic bronchitis(51%), post-obstructive pneumonia(40%) and chronic asthma(4%). CONCLUSION: Because BAF is frequently associated with chronic bronchitis and obstructive pneumonia as well as tuberculosis, a careful clinical evaluation and accurate differential diagnosis is more essential than empirical anti-tuberculous medication.

Difficult Intubation due to Diffuse Type of Tracheo-bronchial Stenosis (complete tracheal rings) from Pulmonary Arterial Sling: A case report

Pulmonary arterial sling, a rare developmental vascular anomaly forms a sling around the distal trachea and the proximal right main bronchus, where it sometimes makes tracheo-bronchial stenosis. Tracheobronchial stenosis from pulmonary arterial sling may produce non-specific symptoms of stridor, noisy breathing, dyspnea, recurrent upper respiratory tract infection, chronic cough, and dysphagia. The diagnosis of this anomaly begins with a high index of suspicion because of the lack of pathognomonic finding on usual evaluation. In this case, initial difficult intubation makes us evaluate further. Other cases reported the diagnosis is established by imaging studies, usually MRI and angiography. But, when our case was evaluated, we used cervico-thoracic enhanced computered tomography and tracheal fluoroscopy. Up to now, tracheobronchial stenosis from vascular anomaly is a rare and challenging disorder with a poor prognosis. However, early exact diagnosis would make us perform the accurate surgical treatment and reduce the mortality and morbidity.

Left Lower Lobectomy with Bronchoplasty for Treatment of Bronchial Stricture / 대한흉부외과학회지

A case of endobronchial tuberculosis with left main bronchial stenosis and atelectasis of left lower lobe in a 26-year-old female is reported. She had taken antituberculous agents for 9 months, but she complained of chest pain and coughing. Bronchoscopy revealed patency of left upper bronchus and bronchiectasis of left lower lobe. She underwent left lower lobectomy with bronchoplasty. After the operation she had significant improvement of pulmonary function. Although surgical treatment of endobronchial tuberculosis is controversial, bronchoplastic surgery can be an effective treatment of tuberculous bronchial stenosis because it relieves patients from symptoms by preserving lung functions.

Two Cases of Post-traumatic Bronchial Stenosis Diagnosed by Flexible Bronchoscopy

Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. It may be followed by bronchial stenosis and subsequent atelectasis. We reviewed two patients with traumatic tracheobronchial injuries sustained after vehicular accident. Bronchial stenosis was suspected due to atelectasis which was first detected 5 days and 11 days after the accident, respectively. They didn't respond to conservative management such as chest physiotherapy for about 2 weeks. Flexible fiberoptic bronchoscopy confirmed bronchial stenosis at the left main bronchus in one patient and at the left upper lobe bronchus in the other. The stenotic bronchi were corrected by resection and end-to-end anastomosis, and bronchoscopy performed postoperatively showed good repair. The patients were discharged without complications. Flexible bronchoscopy is useful and reliable in children as well as in adults for early diagnosis of traumatic tracheobronchial injuries. Resection and end-to-end anastomosis is successful in these cases.

A Case of Pulmonary Artery Sling Associated with Left Bronchial Stenosis and Patent Ductus Arteriosus

Pulmonary artery sling is a rare and potentially lethal vascular anomaly wherein the anomalous left pulmonary artery arises from the posterior aspect of the right pulmonary artery and passing to the left lung between the trachea and the esophagus which causes respiratory distress in infants and children due to the extrinsic compression of the airway by the anomalous vessel. Associated anomalies are common, particularly those of the tracheobronchial tree. The most common lesions are hypoplasia of the distal trachea and right main stem bronchus. About 50 percent of patients have cardiovascular anomalies, such as in the left superior vena cava, atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic arch anomalies, tetralogy of Fallot 1 etc. We experienced a case of a 6-year-old boy who showed dyspnea and frequent pneumonia. He was diagnosed with pulmonary artery sling associated with left bronchial stenosis, patent ductus arteriosus, and left superior vena cava which was parven by echocardiographic examinations, spiral computerized tomography of the chest and cineangiography. We report this case with related literature.

The design of trachea-main bronchial covered embranchment stent and the primary clinical application / 介入放射学杂志

Objective To design the trachea main bronchus covered embranchment stent and study the primary treatment for thoracostomach main bronchial fistula and main bronchial stenosis. Methods The stent was designed on the bases of the peculiar anatomic structure and the pathological changes of thoracostomach main bronchial fistula and main bronchial stenosis. Under the fluoroscopic guidance, implantations were carried out in thoracostomach carina fistula 1 case thoracostomach left main bronchial fistula 1, thoracostomach right main bronchial fistula and left main bronchial stenosis 1 case, altogether with 5 stents. Results Stents were placed successfully, not only improving the breathing and living quality but also completing the closure of the ora of the thoracostomach airway fistula with further vanishing of the choke after drinking and eating togather with the inhalation pneumonia. The bronchus became normal in a main bronchial stenosis after the stent was taken out. Conclusions Trachea main bronchial covered embranchment stent could be used to close thoracostomach airway fistula and to treat main bronchial benign/malignant stenosis. The procedure is simple and safe.