PMC5173503_01
(A, B) Initial tracheal computed tomography shows luminal narrowing of the trachea where the narrowest diameter=3.8 mm.
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The CT image showed irregular luminal narrowing of the trachea, with the smallest diameter measuring 3.84 mm (Fig. 1).
Bronchoscopy conducted one week after the tracheal resection with end-to-end anastomosis revealed only mucosal ulceration at the anastomosis site, but no other complications such as re-stenosis were found.
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Tracheal resection with end-to-end anastomosis was performed, and fiber-optic bronchoscopy showed no serious complications one week after the operation (Fig. 2).
(A, B) Bronchoscopy conducted one month after tracheal resection and end-to-end anastomosis showed concentric stenosis beyond the anastomosis site in the upper trachea. The diameter of the lumen was 5 mm, which was equivalent to maximal opened diameter of a forcep. After the forcep passed forward through the stenotic lesion, hypoxia occurred. (C, D) Bronchoscopic cryotherapy was performed on the weblike fibrous stenosis. After six repeats of a freeze-thaw course, each with a 30 second duration, immediate results from the cryotherapy appeared to be effective.
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Bronchoscopy revealed recurrent tracheal stenosis that had formed web-like fibrosis above the previous anastomosis site in the upper trachea (Fig. 3A and B). We therefore decided to perform cryotherapy with flexible bronchoscopy at the site of the stenotic lesion (Fig. 3C and D).
Bronchoscopy was performed one month after undergoing cryotherapy. The web-like stenosis has been improved with luminal diameter over 10 mm (arrow: previous web-like stenosis site, arrow head: previous anastomosis site).
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After one month, airway patency was consistently well maintained (Fig. 4), and the patient was stable without dyspnea, stridor, or wheezing.
(A, B) Tracheal computed tomography was taken two years after receiving cryotherapy. The trachea shows stable airway patency with the smallest tracheal lumen diameter enlarged to 10.3 mm.
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Tracheal CT taken two years after cryotherapy showed no further stenosis at the old lesion site (Fig. 5).