Tracheobronchomalacia post-pneumonectomy: a late complication

Abstract

An 83-year-old male presented with dyspnoea and stridor. He had undergone pneumonectomy 40 years ago. CT scan revealed gross shift of mediastinum (post-pneumonectomy syndrome) with tortuous trachea kinked at the thoracic inlet. Fibre optic bronchoscopy showed a near total expiratory closure of trachea, right main bronchus, and segmental bronchi confirming tracheobronchomalacia. He was managed with long length, low tracheostomy in view of his poor general condition of permitting more invasive procedures. He showed adequate clinical improvement and was discharged home. Tracheobronchomalacia in post-pneumonectomy syndrome requires emergent management. Its occurrence after 40 years is very rare and may be easily missed. It can be diagnosed with dynamic CT and FOB. Although invasive management with stenting or surgical methods is routinely advised, conservative care can be effective in selected cases.

Keywords: Post pneumonectomy syndrome; Post-pneumonectomy; Stridor; Tacheobronchomalacia.

Figure 1

(a) CT scan showing left post pneumonectomy status, and tortuous trachea with acute angulation at thoracic inlet. (b) CT Scan

Figure 2

(a) Fiber optic bronchoscopy with airway open during inspiration. (b) FOB with airway closed during expiration. (c) Airway collapse during expiration