Table 2 Examples of CAO from different etiologies
From: Central airway obstruction: is it time to move forward?
|  | Patient 1 (Fig. 2) | Patient 2 (Fig. 3) | Patient 3 (Fig. 4) |
|---|---|---|---|
Identification | ♀ 81 years old | ♀ 66 years old | ♂ 61 years old |
Etiology of CAO | Post orotracheal intubation | Extrinsic compression caused by a thoracic aorta aneurism | Tumoral extrinsic compression |
Medical history | Chronical renal failure Pulmonary hypertension LICU hospitalization 2Â years before | HIV+ Pulmonary tuberculosis 30Â years before | Smoker with 75 pack-year history |
Clinical manifestations | Progressive dyspnea | Progressive dyspnea Pleuritic chest pain | Pleuritic pain Dyspnea Hoarseness |
Diagnostic evaluation | Expiratory stridor Lung functions tests normal Thoracic CT scan showed mid-tracheal stenosis > 50% Flexible bronchoscopy confirmed diagnosis | Thoracic CT scan showed thoracic aorta aneurism compressing tracheal and main left bronchus Flexible bronchoscopy confirmed diagnosis | Thoracic CT scan showed voluminous adenopatic conglomerate compressing trachea causing a narrowing of > 80% of trachea and LMB Flexible bronchoscopy showed mucosal invasion and confirmed stenosis Bronchial biopsies revealed small cell lung cancer |
Discussion and management | No conditions for surgery Dilatation with rigid bronchoscope unsuccessful Introduction of a silicon Dumon Stent | A silicon Dumon stent was placed in LML as a bridge to endovascular correction of the aneurism | Radiation and chemotherapy were pursued with disappointing results Y silicon Dumon stent was placed as a palliative intention |
Clinical evolution | Immediate relief of dyspnea and improvement of QOL Complicated after 1Â month with stent migration and infection | Difficult extubation after endovascular correction Recurrent mucus plugs with need of repeated bronchoscopies Complicated with voluminous fistula from LMB to mediastinum | Recurrent mucus plugs with need of repeated bronchoscopies A SEMS was placed instead of Dumon stent trying to avoid the repeated mucous obstruction |
Outcome | Died with multi-organic shock from pulmonary origin | Died with infectious complications | Died due to progression of the underlying disease |