PMC9649944_01
Pretreatment chest imaging. (A) Circumferential mediastinal soft tissue density surrounding mid lower trachea, measuring up to 1.6 cm in thickness. (B) Mediastinal mass encasing the mainstem bronchi bilaterally, causing narrowing bilaterally, left greater than right. (C) Two solid noncalcified soft tissue masses at right lung base. Larger measures 5.6 cm, smaller 2.8 cm. Not pictured is the medial right upper lobe mass 3.2 x 3.1 cm, and a peripheral right middle lobe 1.1 cm nodule. (D) Coronal image of the mediastinal mass with resultant narrowing of the trachea and main bronchi.
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Chest computed tomography (CT) showed pneumomediastinum associated with a circumferential mediastinal mass surrounding the mid-lower trachea, proximal mainstem bronchi, along with scattered parenchymal nodules and masses (Fig. 1).
Bronchoscopy before treatment initiated. (A) Bronchoscopic view of the lower trachea showing inspissated tumor, underlying inflammation, and narrowing. (B) Left main bronchus with mucus, underlying inflammation, and narrowing. (C) Bronchus intermedius, showing ulcerative lesions.
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Emergency bronchoscopy showed severe tracheobronchitis with inspissated necrotic tissue in the mid to lower trachea and near-complete obstruction of the left mainstem bronchus and ~60% narrowing of the right main bronchus (Fig. 2).
Bronchoscopy at time of stent removal. (A) Left main bronchus with stent in situ, airway patent with no tumor. (B) Left main bronchus after stent removal with patency maintained. (C) Metallic airway stent after removal.
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Given significant improvement in tumor burden with patency of both bronchi the left main stent was removed, and the airways remained patent (Fig. 3).