Figures
- FIGURE 1
Purely intrinsic malignant central airway obstruction can be treated with debulking. a) A rigid bronchoscope is used to approach a primary tracheal tumour; b) after mechanical coring with the rigid bronchoscope, debulking with a cryoprobe and argon plasma coagulation to achieve haemostasis, airway patency has been re-established; c) surgical pathology results revealed the tumour to be a tracheal adenoid cystic carcinoma.
- FIGURE 2
Excessive dynamic airway collapse (EDAC) is a type of excessive central airway collapse. EDAC is heralded by an exaggerated collapse of the posterior membrane of the central airways. This difference is notable when comparing a, c) inspiratory (a) distal trachea, c) left mainstem) and b, d) expiratory cross-sectional diameters endoscopically or via dynamic imaging.
- FIGURE 3
A mid-tracheo-oesophageal fistula is noted on airway examination. a, b) The oesophageal stent is eroding into the airway; c) a silicone stent is placed to cover the defect; d) the approximation of the two stents seals the defect.
- FIGURE 4
Lobar salvage has questionable physiological benefit, which is probably more pronounced in the setting of malignant airway disease. The left upper lobe bronchus was noted to be fully occluded; concurrent endobronchial ultrasound needle aspiration showed metastatic disease with poorly differentiated adenocarcinoma. The patient underwent local radiation and systemic chemotherapy; endobronchial therapeutic intervention was not undertaken due to the lack of central airway involvement and the malignant nature of the airway disease.
- FIGURE 5
An iCAST is a vascular stent applied to manage bronchial stenosis. An iCAST stent is being deployed under fluoroscopic guidance in a patient with lobar stenosis. Fluoroscopically visible markers (such as paper clips) can assist in marking the proximal and distal stent landing points.
Tables
- TABLE 1
Summary of key points to consider when evaluating stent placement in specific clinical scenarios
Malignant central airway obstruction In exclusively intrinsic airway disease, consider stenting only if acceptable airway patency cannot be achieved with debulking alone Fibrosing mediastinitis Limited published data
Due to the nature of the pathology, heightened concerns for mucosal bleeding, migration and excessive granulation tissue formationExcessive dynamic airway collapse and tracheobronchomalacia Essential to treat any co-existing underlying disease, such as COPD
Increased risk of short-term and long-term complicationsTracheo-oesophageal fistula and dual stenting A careful assessment of fistula aetiology, fistula size, history of prior treatments, local anatomy, overall prognosis and goal(s) of care is needed prior to stent consideration Distal airway stenting The physiological benefit remains in question Subglottic stenosis Surgery is the definitive treatment
Bronchoscopic intervention of any kind should only be considered in patients who are unfit for surgery, decline surgery or in an emergency airway obstruction (for rapid airway stabilisation, this should be followed by a surgical evaluation)Relapsing polychondritis Medical management is the cornerstone of treatment
Due to the inflammatory nature of the disease, airway stenting should be approached with caution
