PMC6677927_01
Chest computed tomography (CT) findings at initial presentation. The image shows tracheal stenosis (arrow) with prominent lumen thickening (a), and the entrance part of the left main bronchus stenosis (b; arrow head). Anteroposterior (c) and lateral (d) views of 3D reconstruction CT showing stenosis of the trachea from beneath the annular cartilage to the middle trachea (52 mm in length) and severe stenosis in the left main bronchus.
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Chest computed tomography (CT) examination including three-dimensional reconstructions revealed thickening of the tracheal lumen and deformation of the tracheal cartilage from the annular cartilage to the middle trachea (length, 52 mm; luminal diameter, 4 mm) and severe stenosis in the orifice of the left main bronchus (Fig. 1a-d).
Photographs showing tracheal and left main bronchial stenosis during treatment. Each line shows the change with treatment at the same site. The horizontal row is in order of treatment progress.
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After maximum cauterization of the scar site with the laser (Fig. 3c and d), balloon dilatation was performed at an expansion pressure of 4.5 atm (balloon diameter: 13.5 mm) followed by 8 atm (balloon diameter: 15 mm) thrice each, with simultaneous observation of the lumen with the bronchoscope (Fig. 2).
Photographs showing the balloon dilatation catheter and laser cauterization system used for treatment. The expansion diameter can be controlled in three stages according to the pressure of the inflation device (a, b). The laser system is a powerful combination of 80 Watts Holmium and 100 Watts Nd:YAG lasers. Irradiation is performed with a laser fiber (c, d).
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CRE  Pulmonary Balloon Dilatation Catheter (Boston Scientific Corporation, Marlborough, MA, USA; Fig. 3a and b) was introduced over the wire and placed in the tracheal stenosis area. After maximum cauterization of the scar site with the laser (Fig. 3c and d), balloon dilatation was performed at an expansion pressure of 4.5 atm (balloon diameter: 13.5 mm) followed by 8 atm (balloon diameter: 15 mm) thrice each, with simultaneous observation of the lumen with the bronchoscope (Fig. 2).
Chest computed tomography (CT) findings during the follow-up period after the first balloon dilatation. The image shows mildly improved tracheal stenosis (arrow) after initial dilatation (a), restenosis after 2 months of initial treatment (b), and no restenosis even after 22 months (c).
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CT scan showed restenosis of the trachea (Fig. 4a and b). Consequently, we decided to perform balloon dilatation with laser cauterization after 3 months of the initial treatment. Even after 22 months of the treatment, he was free from symptoms and good patency of the trachea was maintained, as revealed by the chest CT examination (Fig. 4c).