PubMed · 4464675
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R Lesch. 1974-03-31. [Lung and environment].. https://pubmed.ncbi.nlm.nih.gov/4464675/
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BACKGROUND: We reviewed our experience to determine the role of endoscopic airway stents in children with tracheobronchial obstruction. METHODS: Seventeen children (10 boys and 7 girls) aged 2 months to 16 years underwent tracheobronchial stenting. Etiology of the tracheobronchial obstruction included external vascular compression (n = 9); tracheobronchial anastomotic strictures after heart-lung/lung transplantation (n = 4); airway compression by malignant mediastinal mass (n = 2), and subglottic/high tracheal stenosis after prolonged intubation with a tracheostomy in situ (n = 2). Indications for airway stenting were failure to wean from ventilator after a mean of 82.5 days (range, 2 to 210) in 8 children; and dyspnea or stridor in the remaining 9 children. RESULTS: Ten children had a total of 24 uncovered self-expanding metal stents (either Magic Wallstent or Ultraflex Microvasive) and 7 children had silicone stents (2 straight, 3 Y and 2 T tube stents). At follow-up at 1 week to 72 months (median 21), only 8 of 17 (47%) children were alive but all the deaths were secondary to the underlying pathology and not related to tracheobronchial stenting. Six of 8 ventilator-dependent children were extubated after a mean of 5.3 days (range, 2 to 11) after airway stenting. For the 9 children stented for dyspnea, mean Medical Research Council dyspnea score decreased from 3.0 to 1.6 after stenting. CONCLUSIONS: Tracheobronchial stenting in children is only rarely needed and often undertaken in dire circumstances. The procedure has led to significant symptomatic benefit in dyspneic children and has enabled ventilator-dependent children to be extubated. Medium-term outlook after stenting with self-expanding metal stents for vascular compression of the airway is encouraging. The long-term outcome remains uncertain, however, and is ultimately influenced by the underlying disease.
Paired inspiratory and dynamic expiratory multislice CT imaging is a promising method for diagnosing TBM. A low-dose technique should be considered for the dynamic portion to reduce radiation exposure. Visual and quantitative analysis of the central airways provide a comprehensive assessment by allowing for the accurate diagnosis of TBM, determining its extent, assessing for predisposing conditions, and aiding selection of candidates for stent placement or tracheoplasty procedures. This technique can also be helpful for assessing response of airway dynamics following therapeutic intervention.
Multislice helical CT has revolutionized the non-invasive evaluation of the central airways with CT. The quick speed of image acquisition afforded by MSCT improves the quality of end-inspiration images and has expanded the ability to assess the airway during dynamic exhalation. Furthermore, the improved quality of multiplanar and three-dimensional images provided by MSCT has ushered in an exciting era of alternative methods of viewing CT data that are more visually accessible and often more anatomically meaningful. At present, the author routinely obtains multiplanar reformation and three-dimensional images for assessment of a variety of central airway abnormalities, including airway stenoses and webs, complex airway diseases, extrinsic airway compression, tracheobronchomalacia, and poststent placement. Further advances in CT technology, data processing, and image display, and increased clinical experience with advanced imaging reconstruction methods, will likely further expand the role of multiplanar and three-dimensional reconstruction images in the assessment of a wide variety of central airways disorders in the near future.