Infected tracheal diverticulum: a rare association with alpha-1 antitrypsin deficiency / Divertículo da traqueia infectado: um caso de associação rara com deficiência de alfa-1 antitripsina

Tracheal diverticulum, defined as a benign outpouching of the tracheal wall, is rarely diagnosed in clinical practice. It can be congenital or acquired in origin, and most cases are asymptomatic, typically being diagnosed postmortem. We report a case of a 69-year-old woman who was hospitalized after presenting with fever, fatigue, pleuritic chest pain, and a right neck mass complicated by dysphagia. Her medical history was significant: pulmonary emphysema (alpha-1 antitrypsin deficiency); bronchiectasis; and thyroidectomy. On physical examination, she presented diminished breath sounds and muffled heart sounds, with a systolic murmur. Laboratory tests revealed elevated inflammatory markers, a CT scan showed an air-filled, multilocular mass in the right tracheal wall, and magnetic resonance imaging confirmed the CT findings. Fiberoptic bronchoscopy failed to reveal any abnormalities. Nevertheless, the patient was diagnosed with tracheal diverticulum. The treatment approach was conservative, consisting mainly of antibiotics. After showing clinical improvement, the patient was discharged.

Divertículos da traqueia são evaginações benignas da parede traqueal e raramente diagnosticados na prática clínica. Podem ser congênitos ou adquiridos, e na maioria dos casos são assintomáticos, sendo tipicamente diagnosticados em estudos post-mortem. Relatamos o caso de uma mulher de 69 anos que foi hospitalizada após apresentar febre, fadiga, dor torácica pleurítica e uma massa cervical à direita complicada por disfagia. Tinha antecedentes pessoais de enfisema pulmonar (deficiência de alfa-1 antitripsina), bronquiectasias e tireoidectomia. Ao exame físico apresentava murmúrio vesicular diminuído, hipofonese cardíaca e um sopro sistólico. Laboratorialmente apresentava marcadores inflamatórios elevados, e uma TC mostrou uma massa aérea, multiloculada na parede direita da traqueia, achados confirmados por ressonância magnética nuclear. Realizou ainda uma fibrobroncoscopia que se revelou normal. Assumiu-se o diagnóstico de divertículo da traqueia. O tratamento proposto foi conservador, consistindo principalmente de antibioticoterapia. Após melhora clínica, a paciente recebeu alta.

Leishmaniasis mucosa nasolaringotraqueal en un adolescente / Nasolaryngotracheal mucosal leishmaniasis in an adolescent

La leishmaniasis es un problema creciente de salud pública, que produce un gran impacto social. La leishmaniasis laríngea y sin puerta de entrada evidente es rara, en especial en pacientes inmunocompetentes. Describimos un caso de leishmaniasis laríngea con extensión traqueal y estenosis secundaria en un adolescente previamente sano y sin factores de riesgo ambiental o personal.

Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.

Role of endobronchial electrocautery in management of neoplastic central airway obstruction: Initial experience with seven cases.

Background. Central airway obstruction (CAO) due to malignant and benign conditions is common. Tumour ablation by various techniques helps effective palliation of symptoms in such patients. Tumour ablation using endobronchial electrocautery (EBEC) with flexible bronchoscope (FB) is an established procedure. However, there is paucity of data from India on this topic. Methods. EBEC was performed in seven patients with CAO; six of these patients had malignant (non-small cell carcinoma) and one had benign aetiology (tracheal fibro-epithelial polyp) as the cause of CAO. Pre- and post-procedure assessment was done with the help of Speiser’s symptomatic scoring. Results. Mean age of the patients was 52.9±7.0 years; there were five males. All the patients had symptomatic relief after the procedure; in five of them the improvement in symptom scores was significant. No major complication was encountered in any patient. Conclusions. EBEC can be a safe, effective and cost-effective tool for palliation in patients with benign or malignant CAO. It is especially beneficial for centres where cost of bronchoscopic laser and cryotherapy is prohibitive.

Successful double lumen tube insertion in a patient with unanticipated laryngeal and tracheal web.

A 45-year-old female patient admitted for surgical management of carcinoma esophagus, presented with difficulty in insertion of left-sided 37 F and 35 F double lumen tube (Mallinckrodt® Broncho-Cath). Fiberoptic bronchoscopy revealed a subglottic web in the larynx just below the vocal cords and a tracheal web just above the carina. Differential lung ventilation could be achieved with a 35 F internal diameter double lumen tube (Portex® Blueline® Endobronchial tube).

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.

Tracheopathia osteoplastica presenting with haemoptysis in a young male.

A young man presented with infrequent haemoptysis spanning over 10 years. Chest radiograph was normal. However, the computed tomography (CT) of the chest had shown endotracheal wall changes. The diagnosis of tracheopathia osteoplastica was suggested on fiberoptic bronchoscopy and confirmed histologically.

Endotracheal tuberculous stenosis: Ventilation rescue and bronchography guided stenting.

We present the case of a 16-year-old female patient who presented with dyspnoea, cough and noisy breathing that progressed further in hospital with the development of stridor and severe respiratory compromise requiring mechanical ventilatory support. Investigations were consistent with a diagnosis of endotracheal tuberculosis with tracheal and bronchial stenosis. Despite adequate anti-tuberculous therapy and ventilation the patient had high airway pressures, low tidal volumes and hypercapnia, which prevented weaning from mechanical ventilation. Balloon dilatation and stenting of the 4.5cm long, 2.3mm diameter stenotic tracheal segment was performed under radiological guidance. The patient was weaned successfully from the ventilator post-procedure. This report illustrates the successful management of an uncommon presentation of a common disease with modern endoscopic therapy.

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.

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.

Pseudotumor inflamario en tráquea / Inflamatory pseudotumor of the trachea

El pseudotumor inflamario es una lesión no neoplásica localizada usualmente en el parénquima pulmonar y muy raramente en la tráquea(1); de etiología desconocida, generalmente considerada como un proceso reactivo (3), compuesto por una variedad de células inflamatorias y mesenquimales entre las cuales se encuentran células plasmáticas, histiocitos, linfocitos, mastocitos y células mesenquimales fusiformes. Esta variabilidad celular le ha dado un número cambiante de nombres según el tipo celular que predomine (2). El caso presentado es el de un hombre joven de 19 años con un cuadro de obstrucción respiratoria alta debido a una masa tumoral en tráquea a quien luego de la resección se le hace el diagnóstico de pseudotumor inflamatorio de tráquea, el primero reportado en la literatura mundial

Laryngeal squamous carcinoma associated with longstanding localised amyloidosis. A case report.

An unusual case of squamous carcinoma arising in the background of longstanding localised tracheolaryngeal amyloidosis is reported and the relevant literature is briefly reviewed.