Successful management of trachea stenosis with massive substernal goiter via thacheobronchial stent

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Abstract

A case of 65 year-old Chinese male patient with severe tracheal stenosis due to a massive substernal goiter, is presented. MRI and CT scan revealed that the massive substernal goiter was 9.3 × 6.1 × 4.7 cm in size, displacing the trachea and adjacent large vessels to the patient’s right contributing to severe intrathoracic trachea compression up to 6 cm in length and the narrowest caliber of the trachea only 3.0 mm in diameter. To the best of our knowledge, optimal airway management for the massive substernal goiter resection was considered to be temporary tracheobronchial stent placement pre-operation.

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Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis.

Cynthia P Saad, Sudish Murthy, Georgiann Krizmanich … (2003)

s: To report and analyze our 6-year experience with implanting 112 self-expandable metallic stents (SEMSs) using flexible bronchoscopy (FB). Retrospective study, tertiary-care hospital. The studied population consisted of 82 patients (mean age, 59.1 years; range, 37 to 83 years), who received SEMSs from 1995 to 2001 using Wallstent (Boston Scientific; Galway, Ireland) or Ultraflex (Boston Scientific) stents. The indications for stent placement were airway obstruction caused by neoplasia (lung carcinoma [CA], n = 50), airway complications of lung transplantation (LTx) [n = 11], and miscellaneous benign conditions (BCs) [n = 21]. The most frequent clinical presentations for the airway obstruction were moderate-to-severe dyspnea (80%) and coughing (45%). The median follow-up duration for the CA group was 42.0 days (range, 1 to 672 days), 329.0 days (range, 35 to 1,540 days) for patients receiving LTx, and 336.0 days (range, 7 to 2,184 days) for the patients with miscellaneous BCs. The observed complications included infection (15.9%), obstructive granulomas (14.6%), and migration (4.7%). The incidence of granulomas was significantly lower in the patients with CA (4.0%) vs LTx and BC groups (17.3% and 33.3% respectively; p = 0.002). All other assessed variables showed no difference between the three analyzed groups. No cases of mucus plugging or fatal hemoptysis were observed. Forty-four patients (53.7%) had no complications related to the SEMS. The incidence of complications was not related to the type of stent (Wallstent or Ultraflex) or SEMS version (covered or uncovered). Fourteen of the 16 patients (87.5%) who were receiving mechanical ventilation could be weaned after the procedure. There were no deaths related to SEMS placement. An SEMS is a safe and effective modality for malignant as well as selected benign airway obstruction. An SEMS is an acceptable therapeutic alternative in patients with central airway obstruction who are not considered good surgical candidates and are receiving mechanical ventilation. Careful patient selection is of outmost importance for a good outcome after airway stenting. Insertion using FB adds to the ease of the procedure.

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An outcome analysis of self-expandable metallic stents in central airway obstruction: a cohort study

Fu-Tsai Chung, Hao-Cheng Chen, Chun-Liang Chou … (2011)

Background Self-expandable metallic stents (SEMSs) have provided satisfactory management of central airway obstruction. However, the long-term benefits and complications of this management modality in patients with benign and malignant obstructing lesions after SEMS placement are unclear. We performed this cohort study to analyze the outcomes of Ultraflex SEMSs in patients with tracheobronchial diseases. Methods Of 149 patients, 72 with benign and 77 with malignant tracheobronchial disease received 211 SEMSs (benign, 116; malignant, 95) and were retrospectively reviewed in a tertiary hospital. Results The baseline characteristics of patients who received SEMS implantation for benign conditions and those who underwent implantation for malignant conditions were significantly different. These characteristics included age (mean, 63.9 vs. 58; p < 0.01), gender (male, 62% vs. 90%; p < 0.0001), smoking (47% vs. 85%; p < 0.0001), forced expiratory volume in 1 second (mean, 0.9 vs. 1.47 L/s; p < 0.0001), follow-up days after SEMS implantation (median; 429 vs. 57; p < 0.0001), and use of covered SEMS (36.2% vs. 94.7%; p < 0.0001). Symptoms improved more after SEMS implantation in patients with benign conditions than in those with malignant conditions (76.7% vs. 51.6%; p < 0.0001). The overall complication rate after SEMS implantation in patients with benign conditions was higher than that in patients with malignancy (42.2% vs. 21.1%; p = 0.001). Successful management of SEMS migration, granulation tissue formation, and SEMS fracture occurred in 100%, 81.25%, and 85% of patients, respectively. Conclusions Patients who received SEMS implantation owing to benign conditions had worse lung function and were older than those who received SEMS for malignancies. There was higher complication rate in patients with benign conditions after a longer follow-up period owing to the nature of the underlying diseases.

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Anesthesia and thyroid surgery: The never ending challenges

Sukhminder Jit Singh Bajwa, Vishal Sehgal (2013)

Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease.

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Journal ID (nlm-ta): J Cardiothorac Surg

Journal ID (iso-abbrev): J Cardiothorac Surg

Title: Journal of Cardiothoracic Surgery

Publisher: BioMed Central

ISSN (Electronic): 1749-8090

Publication date Collection: 2013

Publication date (Electronic): 15 November 2013

Volume: 8

Page: 212

Affiliations

[1 ]Department of Anesthesiology, the First Hospital of Jilin University, Changchun 130021, Jilin, PR China

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Publisher ID: 1749-8090-8-212

DOI: 10.1186/1749-8090-8-212

PMC ID: 3833183

PubMed ID: 24228633

SO-VID: 846e51d7-3a83-4579-b7d0-7e785edeee55

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This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Successful management of trachea stenosis with massive substernal goiter via thacheobronchial stent

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Most cited references 24

Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis.

An outcome analysis of self-expandable metallic stents in central airway obstruction: a cohort study

Anesthesia and thyroid surgery: The never ending challenges

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