PMC8649689_01
(A) Clubbing digits; (B) collapsed of the bridge of the nose (red arrow); (C) stunted auricles (red arrow); (D) pathology showed multiple necrosis of ear chondrocytes accompanied by inflammatory cell infiltration.
fmed-08-695505-g0001.jpg
PMC8649689_01_fmed-08-695505-g0001.jpg
F1
Physical examination showed that the patient was thin, had clubbing digits, a slightly collapsed bridge of the nose, and had stunted auricles (Figures 1A-C). Pathology reports showed multiple necrotic chondrocytes accompanied by inflammatory cell infiltration (Figure 1D).
(A) Chest CT showed reduced tracheal lumen (red arrow); (B) thickened tracheal wall (red arrow); (C) emphysema and bilateral lung infections; (D) the lumen of trachea during the inspiratory phase (red arrow); (E) the lumen of trachea during the expiratory phase (red arrow); (F) the lumen of both mainstem bronchus during the inspiratory phase; (G) the lumen of both mainstem bronchus during the expiratory phase; (H) pulmonary function tests revealed severe mixed ventilatory dysfunction, which was mainly obstructive; (I-K) after the covered nickel-titanium memory alloy stent was implanted, the lumen was unobstructed (red arrow); (L) pulmonary function tests revealed moderately mixed ventilatory dysfunction, which was mainly obstructive; (M,N) chest CT showed that the lumen of subglottis to the upper of the stent was slightly narrowed (red arrow); (O,P) the stents were well fixed; (R) chest CT showed that the lumen of subglottis to the upper of the stent was severely narrowed; (Q,S,T) the stents were well fixed (red arrow).
fmed-08-695505-g0002.jpg
PMC8649689_01_fmed-08-695505-g0002.jpg
F2
Chest computed tomography (CT) showed reduced tracheal lumen, thickened tracheal wall, emphysema, and bilateral lung infections (Figures 2A-C). Pulmonary function tests revealed severe mixed ventilatory dysfunction, which was mainly obstructive, with a slight decrease in diffusion function (Figure 2H). A chest CT scan including the inspiratory and expiratory phases showed that the lumen of the trachea and main bronchus severely collapsed at the end of expiration compared with inspiration (Figures 2D-G). Subsequently, three nickel-titanium alloy coated memory stents were implanted in the trachea and bilateral main bronchus under local anesthesia (Figures 2I-K). Pulmonary function tests revealed moderate mixed ventilatory dysfunction, which was mainly obstructive, with a slight decrease in diffusion function (Figure 2L). Chest CT showed an unobstructed trachea and bilateral main bronchus, the stent was well-fixed, and the subglottis and upper part of the stent were slightly narrowed (Figures 2M-Q). Emergency chest CT and bronchoscopy showed granulation hyperplasia and scar tissue in the lumen of the subglottis to the upper segment of the tracheal stent, hyperemia and swelling of the mucosa, and a large amount of thick sputum blockage in the lumen, resulting in severe narrowing of the lumen (Figures 2R, 3Q). After the operation, the patient's tracheal stenosis significantly improved, and the bronchoscope was able to enter the distal airway smoothly, enabling the aspiration of large amounts of viscous secretions; the airway stent was in a good position and no serious complications, such as rupture were observed (Figures 3T-X, 2S,T).
(A-G) Bronchoscopy showed that the mucosa of trachea and main bonchus were severely hyperemic and swollen, cartilage was disappeared, and the lumen was stenosis; (H,J) the stents were well fixed; (I) bronchoscopy showed that the lumen of subglottis to the upper of the stent was severe narrowed and accompanied by scar tissue; (K,L) bronchoscopy showed that the mucosa was severe swollen, cartilage was disappeared, and granulation hyperplasia can be found (red arrow); (M) CO2 cryotherapy of granulation tissue; (N) argon plasma coagulation was performed; (O) CO2 cryoablation was performed; (P) the airway lumen is obviously enlarged after therapy; (Q) bronchoscopy showed that the lumen of subglottis to the upper of the stent was severe narrowed and accompanied by scar tissue (red arrow); (R,S) bronchoscopy-guided argon plasma coagulation and CO2 cryoablation were performed; (T) the airway lumen is obviously enlarged after therapy; (U,V) granulation and a large amount of thick sputum blockage in the lumen; (W) CO2 cryotherapy of granulation tissue; (X) the airway lumen is further enlarged after therapy with ECMO assist.
fmed-08-695505-g0003.jpg
PMC8649689_01_fmed-08-695505-g0003.jpg
F3
Subsequently, bronchoscopy showed that the mucosa of the trachea and main bronchi were severely hyperemic and swollen, and the cartilage had disappeared (Figures 3A-G). Bronchoscopy showed that the lumen of the subglottis to the upper segment of the tracheal stent was narrow, the mucosa was severely swollen, cartilage had disappeared, and granulation hyperplasia was present (Figures 3H-L). The narrow lesion was significantly improved after bronchoscopy-guided argon plasma coagulation, and CO2 cryoablation was performed, which significantly relieved the patient's symptoms (Figures 3M-P). Emergency chest CT and bronchoscopy showed granulation hyperplasia and scar tissue in the lumen of the subglottis to the upper segment of the tracheal stent, hyperemia and swelling of the mucosa, and a large amount of thick sputum blockage in the lumen, resulting in severe narrowing of the lumen (Figures 2R, 3Q). For the intervention, we first used a CO2 cryotherapy instrument to remove the local granulation tissue during the operation and then a needle-shaped high-frequency electrosurgical knife to make a radial cut on the narrow opening (Figure 3R). Finally, CO2 cryoablation was performed (Figure 3S). After the operation, the patient's tracheal stenosis significantly improved, and the bronchoscope was able to enter the distal airway smoothly, enabling the aspiration of large amounts of viscous secretions; the airway stent was in a good position and no serious complications, such as rupture were observed (Figures 3T-X, 2S,T).
Clinical history of the patient. APC, argon plasma coagulation; HFEK, high-frequency electrosurgical knife.
fmed-08-695505-g0004.jpg
PMC8649689_01_fmed-08-695505-g0004.jpg
F4
Clinical history of the patient can be seen in Figure 4.