PMC9841052_01
Chest X-ray at end-inspiratory (A) and forced expiratory phases (B). Narrowing of the bronchi is evident at the forced expiratory phase (arrows).
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Chest radiography revealed narrowing of the bronchi on exhalation (Fig. 1), which was further confirmed by CT at the end of forced expiration/inspiration, revealing a collapsed trachea, leading to a diagnosis of ECAC.
Virtual endoscopic images generated by CT data at end-inspiratory (A) and forced expiratory phases (B). Virtual endoscopic image created by CT data showing intrusion of the tracheobronchial posterior membrane during expiration, attributed to the weakness of the longitudinal muscle fibers (B). Bronchoscopy (C) (D) reveals airway collapse at expiration, affecting the trachea and opening of the bronchi. The degree of narrowing in the anteroposterior diameter is apparent, compared to that of luminal narrowing.
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Virtual endoscopic images were generated from the CT data (Fig. 2A and B), showing protrusion of the membranous portion of the trachea at exhalation. Bronchoscopy revealed protrusion of the membranous portion of the central airways into the tracheal lumen (Fig. 2C and D).
Chest X-ray taken after placing a silicone Y stent under rigid bronchoscopy. As expected, stenting improves the patient's airway symptoms initially, suggesting potential benefit from surgical fixation. However, the patient cannot tolerate the irritation cause by the stent.
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To estimate the efficacy of this surgical procedure, a dynamic Y tracheobronchial stent was placed (Fig. 3), following an algorithm commonly used to manage ECAC.
Intraoperative findings. (A, B) Photos showing a rigid polypropylene mesh (arrows) sutured onto the membranous portion of the trachea. (C) Illustration showing the polypropylene mesh splinting the tracheobronchial tree. E, esophagus; M, membranous portion; V, Vagus nerve; RUL, right upper lobe of the lung.
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This fixation was from the upper trachea through the carina, down to the left main bronchus close to the secondary carina, as well as down the right main bronchus and bronchus intermedius (Fig. 4).
Comparison of CT images at end-inspiratory and forced expiratory phases before tracheobronchoplasty (TBP) (A) and 6 months after TBP (B) at the level of the aortic arch and at the level caudal to the carina. Protrusion of the posterior membranous portion of the central airway and resulting airway collapse is evident at expiration before TBP. However, these findings are significantly improved after TBP.
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Six months later, CT demonstrated good outcomes of surgery (Fig. 5).