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Chest radiograph obtained 1 week prior to emergency transfer.. A. PA chest radiograph. Note the lack of clear signs of airway obstruction.. B. Lateral chest radiograph. Note the anterior mediastinal fullness and the narrowing of the tracheal airway.
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A chest X-ray (CXR) was obtained one week prior to transfer, but the results were interpreted as negative (Fig. 1A and B).
CT imaging prior to transfer and 1 week after the chest radiograph.. A. (Top Left) Axial cut at level of aortic arch.. B. (Bottom Left) Axial cut just below carina.. C. (Right) Representative coronal image.
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When a computed tomography (CT) scan was eventually obtained by her local physicians, she was found to have severe airway obstruction involving the subcarinal space and anterior mediastinum, such that both the left and right mainstem bronchi were severely occluded (Fig. 2A-C).
Bronchoscopic images.. A. (Top left)Main carina. Tumor infiltration is noted.. B. (Bottom left) Left mainstem bronchus at mid bronchus.. C. (Top Right) Superior segment bronchus with suspected edema fluid.. D. (Bottom Right) Stent within trachea.
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Inspection bronchoscopy confirmed a bilateral mass-induced airway obstruction in the mainstem bronchi (Fig. 3A and B). One notable feature was the presence of air bubbles and yellowish fluid spilling from the orifice of several airways, particularly the left lower lobe superior segment (Fig. 3C). Next, we proceeded to place a hybrid self-expanding silicone/nitinol Y stent (Fig. 3D).