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Review
. 2020 Mar;12(3):1100-1111.
doi: 10.21037/jtd.2019.11.43.

Idiopathic subglottic stenosis: a review

Carlos Aravena  1   2 , Francisco A Almeida  1 , Sanjay Mukhopadhyay  3 , Subha Ghosh  4 , Robert R Lorenz  5 , Sudish C Murthy  6 , Atul C Mehta  1
Affiliations
Review

Idiopathic subglottic stenosis: a review

Carlos Aravena et al. J Thorac Dis. 2020 Mar.

Abstract

Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis. The diagnosis of this entity is difficult, usually delayed and confounded with other common respiratory diseases. No apparent etiology is identified even after a comprehensive workup that includes a complete history, physical examination, pulmonary function testing, auto-antibodies, imaging studies, and endoscopic procedures. This approach, however, helps to exclude other conditions such as granulomatosis with polyangiitis (GPA). It is also helpful to characterize the lesion and outline management strategies. Therapeutic endoscopic procedures and surgery are the most common management modalities, but medical therapy can also play a significant role in preventing or delaying recurrence. In this review, we describe the morphology, pathophysiology, clinical presentation, evaluation, management, and prognosis of iSGS.

Keywords: Idiopathic subglottic stenosis (iSGS); granulomatosis with polyangiitis (GPA); laryngostenosis; subglottic stenosis (SGS); tracheal stenosis.

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Conflict of interest statement

Conflicts of Interest: The series “Interventional Pulmonology” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Idiopathic Subglottic Stenosis in a 55-year-old female. Note concentric web-like nature of the lesion.
Figure 2
Figure 2
Post intubation stenosis from the high cuff pressure injury.
Figure 3
Figure 3
Granulomatosis with polyangiitis related airway stenosis. (A) Subglottic stenosis in a patient with GPA; (B) Tracheal stenosis related to GPA. GPA, granulomatosis with polyangiitis.
Figure 4
Figure 4
Truncus medius anastomosis following a potassium pill aspiration.
Figure 5
Figure 5
Idiopathic subglottic stenosis longer than 1 cm in length.
Figure 6
Figure 6
Subglottic stenosis, sagittal view.
Figure 7
Figure 7
Histologically, iSGS is characterized by dense, keloid-like fibrosis (A). The overlying epithelium often shows squamous metaplasia (B). Cartilage is histologically normal (C). iSGS, idiopathic subglottic stenosis.
Figure 8
Figure 8
Flow-volume loop is demonstrating fixed upper airway obstruction [Inner loop]. Dots denote predicted values. Outer loop depicts near normalization of the flow rates following appropriate treatment.
Figure 9
Figure 9
Axial (A,B), coronal (C) and sagittal (C) CT scan of the trachea depiction Subglottic Stenosis.
Figure 10
Figure 10
Radial incisions on the concentric scar.
Figure 11
Figure 11
Gentle dilatation using a controlled radial expansion balloon.
Figure 12
Figure 12
Mitomycin application.
See this image and copyright information in PMC

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