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. 2015 Mar;7(3):E54-7.
doi: 10.3978/j.issn.2072-1439.2015.01.26.

Flexible bronchoscopic excision of a tracheal mass under extracorporeal membrane oxygenation

Jae Jun Kim  1 , Seok Whan Moon  1 , Yong Hwan Kim  1 , Si Young Choi  1 , Seong Cheol Jeong  1
Affiliations

Flexible bronchoscopic excision of a tracheal mass under extracorporeal membrane oxygenation

Jae Jun Kim et al. J Thorac Dis. 2015 Mar.

Abstract

Tracheal tumor is a rare but life-threatening condition that can cause obstruction of the airway. Management of tracheal tumors is very challenging and includes surgical resection, radiotherapy, and therapeutic bronchoscopy. Herein, we present a very rare case of an 88-year-old female patient with a tracheal mass due to direct invasion of a mediastinal teratoma. We devised a new method for resection of the tracheal mass because management of her airway and the tracheal mass by conventional methods was impossible. We successfully resected the tracheal mass with flexible bronchoscopic electrocautery under extracorporeal membrane oxygenation (ECMO) without any complications. When management of a patient's airway and tracheal mass are impossible by conventional methods, this technique may be very useful.

Keywords: Tracheal mass; bronchoscopy; extracorporeal membrane oxygenation (ECMO).

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Figures

Figure 1
Figure 1
Preoperative chest X-ray and chest CT reveals an enhancing mass, about 5.0 cm × 3.9 cm, in the upper anterior mediastinum and a nodular lesion in the trachea, about 1.1 cm × 0.7 cm, suggesting invasion of the mediastinal mass causing near-total obliteration of the tracheal lumen. Furthermore, there was severe tracheal curvature and deviation to the right side due to the mediastinal mass. Surgical resection of the trachea or tracheal mass was impossible, and we could not perform a tracheostomy or endotracheal intubation to secure the airway due to the mediastinal and tracheal masses.
Figure 2
Figure 2
Preoperative flexible bronchoscopy reveals a polypoid mass, measuring about 1.5 cm in diameter and obliterating nearly the entire lumen of the trachea, located about 3.0 cm below the vocal cords, and severe curvature and deviation of the trachea. The severe curvature and deviation of the trachea, the characteristics of the mass, and the risk of ventilation failure during the procedure precluded intervention with rigid bronchoscopy.
Figure 3
Figure 3
Postoperative bronchoscopic findings. (A) Immediate postoperative findings; (B) findings on the seventh postoperative day. Postoperative bronchoscopy shows near-complete excision of the tumor.
See this image and copyright information in PMC

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