Tracheobronchomalacia post-pneumonectomy: A late complication

Abstract

An 83-year-old male presented with dyspnoea and stridor. He had undergone pneumonectomy 40 years ago. CT scan revealed gross shift of mediastinum (post-pneumonectomy syndrome) with tortuous trachea kinked at the thoracic inlet. Fibre optic bronchoscopy showed a near total expiratory closure of trachea, right main bronchus, and segmental bronchi confirming tracheobronchomalacia. He was managed with long length, low tracheostomy in view of his poor general condition of permitting more invasive procedures. He showed adequate clinical improvement and was discharged home. Tracheobronchomalacia in post-pneumonectomy syndrome requires emergent management. Its occurrence after 40 years is very rare and may be easily missed. It can be diagnosed with dynamic CT and FOB. Although invasive management with stenting or surgical methods is routinely advised, conservative care can be effective in selected cases.

Underestimated Aetiology Of Tracheobronchomalacia In Adults In China

“…Congenital TBM results from abnormalities of airway maturation, most seen in children born with esophageal atresia and esophageal tracheal stula [24,25]. Adult TBM occurs in the normally developed trachea due to chronic airway in ammation, mechanical causes and congenital causes [12][13][14][15][16][17][18][19][20][21]. In this study, the etiologies of TBM included COPD, tracheobronchial tuberculosis, bronchiectasis, relapsing polychondritis, and chronic bronchitis.…”

“…), chronic airway in ammation [chronic obstructive pulmonary disease (COPD), uncontrol asthma, recurrent infections, relapsing polychondritis, tuberculosis, malignant airway obstruction, etc. ), and congenital causes (Mounier-Kuhn syndrome) [11][12][13][14][15][16][17][18][19][20][21][22][23]. Symptoms, signs, onset age, disease severity and prognosis of TBM are considerably different due to different etiologies.…”