Skip to Main Content

++

Endobronchial lesions are caused by a variety of benign and malignant disease processes. When such lesions obstruct the central airways, trachea, or main stem bronchi, they quickly turn life-threatening. The incidence of central airway obstruction (CAO) has increased largely because of the prevalence of lung cancer. It causes significant morbidity and, without treatment, may lead to suffocation and death. This chapter reviews the gamut of available endobronchial techniques for managing acute CAO, including endobronchial resection with electrocautery, argon plasma coagulation, laser therapy, photodynamic therapy, cryotherapy, external beam radiation and brachytherapy, and airway stents. The most comprehensive use of these techniques should be offered at centers experienced in the management of complex airway disorders with the full array of endoscopic and surgical options at their disposal.

++

CAO causes significant morbidity and mortality in patients with malignancies that affect the upper airways. Although the precise incidence and prevalence of CAO are unknown, current lung cancer rates suggest that an increasing number of patients experience complications of proximal endobronchial disease.1 It has been estimated that approximately 20–30% of patients with lung cancer develop complications associated with airway obstruction (i.e., atelectasis, pneumonia, or dyspnea)2 and that up to 40% of lung cancer deaths are caused by locoregional disease.3 With increased use of temporary artificial airways, such as endotracheal intubation, in a growing elderly population, the incidence of CAO from malignant, nonmalignant, or iatrogenic complications is also predicted to rise.

++

The most frequent cause of malignant CAO is by direct invasion of an adjacent tumor, chiefly bronchogenic carcinoma, secondarily esophageal and thyroid carcinoma. Primary tumors of the central airway are relatively uncommon. Most primary tracheal tumors are squamous cell carcinoma or adenoid cystic carcinoma. Distal to the carina, the carcinoid tumors account for the majority of primary airway tumors.4 Distant tumors, such as renal cell, breast, and thyroid, also may metastasize to the airway. Although the epidemiologic data are limited, the most commonly encountered nonmalignant causes of CAO are stenosis from the proliferation of granulation tissue resulting from prior endotracheal or tracheostomy tubes, airway foreign bodies, and tracheo- or bronchomalacia.5

++

The clinical presentation of patients with CAO secondary to endobronchial lesions depends not only on the underlying disease but also on the location and rate of progression of the airway obstruction, the patient's underlying health status, and other associated symptoms, such as postobstructive sequelae. Mild airway obstructions may have only slight effect on airflow; hence the patient may be asymptomatic. However, the inflammation associated with even mild respiratory tract infections can cause mucosal swelling and mucus production, which may further occlude the lumen. For this reason, patients sometimes are misdiagnosed with exacerbations of chronic obstructive pulmonary disease or asthma, especially when symptoms such as wheezing and dyspnea improve with therapy aimed at treating the superimposed infection.

++

Typically, the trachea must be significantly narrowed (<8 mm) before exertional dyspnea is noted. The lumen diameter must be less than 5 mm before symptoms occur at rest.6 As a consequence of the dramatic loss of lumen diameter ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.