Bronchoscopy Laser and Silicone Y-Stents as Emergency Airway Management in Central Airway Stenosis Due to Secondary Thyroid Carcinoma: A Case Report

Abstract

Total airway obstruction in thyroid cancer is rare and has high morbidity and mortality. Airway management in such cases is challenging, especially in cases in which thyroid masses cannot be totally resected. It is important to choose the appropriate airway treatment modality. Currently, therapeutic rigid bronchoscopy procedures and endoluminal lasers, as well as airway stent insertion, are a management modality of near-total malignant airway obstruction. We report a rigid bronchoscopy procedure combined with laser and Y-stent silicone insertion in thyroid cancer with extension infiltration, as well as compression in the trachea covering the subglottic tracheal area up to the main carina and tracheo-bronchomalacia, manifesting as acute respiratory failure.

Silicone stent placement for tracheal stenosis induced by a giant goiter due to Graves’ disease: a case report

“…Thyroid tumors with severe tracheal stenosis are rare ( 1 ). Most cases of tracheal stenosis are caused by malignant thyroid tumors, with an incidence of approximately 6–14% ( 2 ). Significant airway stenosis due to benign thyroid tumors is even rarer, with an incidence of approximately 1–2% ( 3 ).…”

“…However, emergency thyroidectomy in patients with dyspnea may increase the risk of surgical complications, such as hemorrhage, recurrent laryngeal nerve injury, and hypoparathyroidism ( 5 ). Emergency tracheostomy is also an effective alternative strategy to resolve an airway obstruction ( 2 , 9 ). However, when the goiter is very large, it is difficult to reach the trachea and safely perform tracheostomy ( 9 ).…”

“…Furthermore, if tracheal stenosis is located on the caudal side of the neck, it may not be possible to effectively secure the airway. A tracheal stent is a minimally invasive and effective method for securing the airway for severe airway stenosis ( 2 , 6 , 9 ). In the present case, emergency thyroidectomy was considered to be dangerous due to the high risk of complications associated with the large size of the goiter and advanced age of the patient.…”

“…Significant tracheal stenosis in thyroid disease is rare ( 1 ). Most cases of severe airway stenosis are caused by malignant thyroid tumors ( 2 ); however, benign thyroid tumors may be responsible in rare cases ( 3 , 4 ). Severe airway stenosis is a life-threatening condition causing respiratory distress and requires immediate action for airway management ( 5 - 8 ).…”

“…Thyroidectomy is necessary for definitive treatment ( 5 - 8 ). Tracheostomy may also effectively secure the airway ( 2 , 9 ). However, if the thyroid tumor is large, this treatment is difficult ( 5 , 6 , 8 , 9 ), and, thus, alternative strategies to surgical treatment are required ( 5 - 7 ).…”