PMC7606407_01
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(A) Airway reconstruction shows the localized stenosis of the lumen in the cervical trachea. (B) The irregular narrow lumen of the cervical trachea shown by a CT scan. (C) Cervical stenosis was observed through the subglottic region during flexible bronchoscopy. (D) Bronchoscopy showing segmental concentric stenosis.
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F1
Neck and chest CT showed segmental stenosis at the cervical trachea (Figures 1A,B). Bronchoscopy revealed concentric stenosis with absent cartilage rings at the cervical trachea, while the middle trachea and the distal trachea were normal (Figures 1C,D).
(A) Bronchoscopy showing severe stenosis at the distal tracheal and juxa-tacarinal location. (B) During operation, soft stenosis without cartilage rings located in the distal trachea and bilateral main bronchi opening. (C) Bronchoscopy demonstrated that the carina and bilateral main bronchus were unobstructed after the operation. (D) Anastomotic fracture, 9 days after the operation.
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F2
Emergency bronchoscopy showed severe stenosis of the distal trachea at the juxtacarinal location (Figure 2A). He then underwent emergency surgery under cardiopulmonary bypass, which revealed that the distal tracheal and bilateral main bronchi openings were soft and tissue-like, with an extremely narrow diameter of about 1.5 mm (Figure 2B). After the operation, bronchoscopy showed that the carina and the bilateral bronchi were clear, permitting the passage of a 4-mm bronchoscope (Figure 2C). Bronchoscopy revealed anastomotic fracture 9 days after the operation (Figure 2D).
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PMC7606407_05
(A) Bronchoscopy showing complete collapse at the middle to distal trachea. (B) Unblocked trachea after Dumon stent was placed. (C) Malacic lumen at the distal trachea and carina. (D) Complete collapse without cartilage rings at the middle trachea was observed after stent removal. (E) The rigidity of the distal trachea had increased. (F) Unobstructed carina after stent removal.
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F3
Flexible bronchoscopy showed severe malacia of the middle trachea to the distal trachea, and the membranous trachea was widened (Figure 3A). A 7-8 x 25-mm Dumon stent (Novatech S.A.) was placed through the rigid bronchoscope (Figures 3B,C). A careful reevaluation by flexible bronchoscopy indicated a full collapse of the 1.5-cm esophageal-like lumen and no cartilage rings in the middle trachea (Figure 3D). Although the rigidity of the malacic trachea in the distal trachea increased with growth (Figures 3E,F), the trachea was still obstructed.