Images in Clinical Medicine
Postoperative Tracheal Stenosis
N Engl J Med 2010; 362:e5January 14, 2010
- Article
A 45-year-old woman presented for an assessment of breathlessness. She had been receiving inhaled bronchodilators and corticosteroids for years without improvement. Her medical history was notable for prolonged endotracheal intubation 8 years earlier. Examination revealed a biphasic wheeze. Pulmonary-function testing showed marked limitation of the inspiratory and expiratory flow rates, which is consistent with upper airway obstruction, with normal lung volumes and diffusion (Panel A, with each curve representing one breath and positive flow indicating expiration). High-resolution computed tomography of the trachea revealed a narrowing of the trachea 2.8 cm below the vocal cords (Panel B). Bronchoscopy confirmed a circular fibrous tracheal web 2 cm below the vocal cords (Panel C, ring below the vocal cords, around the black opening). A tracheal web is a type of tracheal stenosis with a concentric membrane causing a subglottic stenosis without damage to the cartilage. The stenosis may be congenital or may be a complication of tracheal intubation or tracheostomy. The patient was referred for resection of the tracheal web and for tracheal dilation. This procedure resulted in marked improvement of symptoms and improvement of respiratory flow rates (Panel D, with each curve representing one breath), abolition of stridor, and a reduction of airway resistance (from 0.43 to 0.33 kPa per liter per second [predicted value, 0.22]).
Avijit Datta, M.D.
Hull York Medical School, York, United Kingdom
avijit.datta@york. nhs. uk Alex Cale, F.R.C.S.
Castle Hill Hospital, Kingston-upon-Hull, United Kingdom- Citing Articles (1)
Citing Articles
1
S. Dubner, A. Auricchio, J. S. Steinberg, P. Vardas, P. Stone, J. Brugada, R. Piotrowicz, D. L. Hayes, P. Kirchhof, G. Breithardt, W. Zareba, C. Schuger, M. K. Aktas, M. Chudzik, S. Mittal, N. Varma, , C. Israel (Germany), L. Padeletti (Italy), M. Brignole (Italy). (2012) ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs). Europace 14:2, 278-293
CrossRef
