Complete bronchial stricture and airway management challenges

Taha Z. Shipchandler, Katie Geelan-Hansen, Paul R. Krakovitz

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objective: The purpose of this report is to demonstrate a unique case of severe bronchial stricture and discuss the associated diagnostic and airway management challenges. Study design: The design was that of a case report. Methods: A review of the literature was made. Results: A 15-year-old adolescent boy with a history of renal transplantation 1 year prior presented with a 10-day history of progressive cough and shortness of breath necessitating ventilator support. Chest radiograph and computed tomography showed complete whiteout of the left lung with some areas of hyperinflation of the left upper lobe. Subsequent flexible and rigid bronchoscopy noted a narrowed left mainstem bronchus with no evidence of an intact lumen. After failed attempts at medical treatment and dilation, the patient underwent a left pneumonectomy. He was ultimately discharged home in good condition. Discussion: Bronchial strictures are rare phenomenon with oftentimes unclear etiologies. Atresia of bronchi is even rarer, usually occurring in young males, and may go undiagnosed for 30 years until clinical symptoms occur. Treatment of narrowed segments may involve medical treatment of infectious agents, stent placement, dilation, and sleeve resection. Treatment of atresia or severe stricture may necessitate resection of the lung distal to the affected region. Conclusion: Bronchial strictures and atresias may go undiagnosed for years before pulmonary symptoms occur. Computed tomography and bronchoscopy with biopsies represent the mainstays of diagnosis. Regional lung hyperinflation and peribronchial translucency may hint at bronchial atresia. Treatment paradigms vary from dilation and stent placement to resection of the affected areas. In the absence of a clear etiology for lung whiteout, severe bronchial stricture or atresia should be considered as a possibility.

Original languageEnglish (US)
Pages (from-to)195-197
Number of pages3
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume29
Issue number3
DOIs
StatePublished - May 2008

ASJC Scopus subject areas

  • Otorhinolaryngology

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