Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management

Abstract

Central airway obstructive infections (CAOI) are challenging medical conditions that may represent an advanced and complicated process of ongoing infections. The epidemiology of CAOI is unknown as well as the pathophysiology and the mechanism of development. This is due to sparse data in the literature that consists mainly of case reports and retrospective case series. CAOI can be caused by fungal, bacterial, parasitic and viral infections. Most patients with CAOI can be diagnosed clinically and with chest imaging, which demonstrate obstruction of the central airways. However, bronchoscopy is commonly used to confirm and obtain a specific diagnosis to guide specific therapy. In recent years, interventional pulmonology (IP) is becoming widely available and offer a minimally invasive approach for the management of central airway diseases such as cancers, benign strictures, and other conditions. Various bronchoscopic modalities are used to treat central airway obstruction (CAO), such as mechanical debulking, endobronchial laser therapy, electrocautery, argon plasma coagulation, cryotherapy, and airway stenting. In patients with CAOI, the role of therapeutic bronchoscopy is not clearly defined, but many isolated reports in the literature described bronchoscopic intervention in combination with medical therapy as the initial management approach. In this paper, we present cases of CAOI that underwent bronchoscopic intervention as part of their management. We described the infectious etiology, locations, bronchoscopic findings and bronchoscopic modalities for airway management.

Tracheobronchial Obstruction Due to Blood Clots in Acute Pulmonary Embolism with Cardiac Arrest Managed with Extracorporeal Membrane Oxygenation

“…In addition, the pneumonia was thought to be associated with the formation of blood clots in our patient. Keshishyan et al showed that bacterial infection could result in central airway obstruction, and the immune status of the host is considered to play an important role (14). In our case, Klebsiella pneumonia developed in the right lower lobe, and severe neutrophil infiltration into the blood clot was observed during a pathological examination.…”

Pseudomembranous Tracheobronchitis With Severe Tracheal Stenosis and Masked Bronchial Obstruction

“…We decided to perform urgent tracheotomy to avoid asphyxia. In general, flexible or rigid toilet bronchoscopy is the principal method for improving airway patency in PMTB (2). Although PMTB can cause central airway obstruction, urgent tracheotomy is rarely required (3,4).…”

“…PMTB clinically overlaps with necrotizing tracheobronchitis or plastic bronchitis (PB) and the various reported causative conditions include infection, intubation, inhalation or ingestion of toxic substances, and inflammatory bowel disease (1). The main cause of PMTB is Aspergillus infection and the reported underlying conditions include post-viral infection or an immunocompromised state (2). PMTB is an important condition Reprints are not available from the authors.…”

“…Prompt flexible or rigid bronchoscopy is required for its diagnosis and management. However, urgent tracheotomy is rarely performed because airway obstruction in PMTB is mainly caused by pseudomembranes, and toilet bronchoscopy is usually effective (2)(3)(4). Moreover, no study has reported a case of PMTB in which true (not pseudomembranous) severe tracheal stenosis coexists with pseudomembranous distal bronchial obstruction.…”

Benign Central Airway Obstruction

“…Numerous fungal species have been described to cause central airway obstructive infections including Aspergillus, Fusarium, mucormycosis, and Cryptococcus. 126 In one study, endobronchial aspergillosis accounted for 10.8% of benign airway lesions and was typically identified in immunocompromised patients that had CT images suggestive of malignancy. 127 Airway aspergillosis can be classified into four types: pseudomembranous aspergillus tracheobronchitis (ATB), ulcerative ATB, obstructing ATB, and invasive ATB.…”