Niwas Ram, Chawla Gopal, Pareek Puneet, Chauhan Nishant Kumar, Dutt Naveen
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur.
Department of Radiotherapy, All India Institute of Medical Sciences, Jodhpur.
Monaldi Arch Chest Dis. 2020 Oct 15;90(4). doi: 10.4081/monaldi.2020.1324.
Critical central airway obstruction has always been a dreaded complication to which interventional pulmonologist commonly encounters. There have been various modalities which are used for the management and palliation, which includes mechanical coring, laser, cryoextraction, electrocautery and airway stenting. Rigid bronchoscopy with or without jet ventilation has been corner stone of therapeutics and palliation of central airway obstruction. There are only a few conditions where it is not possible to use rigid bronchoscopy. Here we report a case of metastatic tracheal tumour which presented with critical airway obstruction in a patient who had atlantoaxial instability (AAI) due to rheumatoid arthritis. Here we used endobronchial ultrasound scope (EBUS) via esophageal route, i.e. EUS-B guided approach for sampling of the tracheal tumour, and intratumoral chemotherapy was instilled in multiple sessions, which resulted in shrinking of tumour, thus relieving the critical airway obstruction. This is the first report of using EUS-B approach for intratumoral chemotherapy for tracheal tumors. Bronchoscopic intratumoral chemotherapy therapy (BITC) in tracheal tumors is also one of the options but has not been explored much and there has been a dearth of literature for it.
严重的中央气道阻塞一直是介入肺科医生常遇到的可怕并发症。目前有多种用于治疗和缓解的方法，包括机械取芯、激光、冷冻切除、电灼和气道支架置入。有或没有喷射通气的硬质支气管镜检查一直是中央气道阻塞治疗和缓解的基石。只有少数情况下无法使用硬质支气管镜检查。在此，我们报告一例转移性气管肿瘤病例，该患者因类风湿性关节炎导致寰枢椎不稳（AAI），出现严重气道阻塞。在此，我们通过食管途径使用支气管内超声内镜（EBUS），即EUS-B引导的方法对气管肿瘤进行采样，并多次进行瘤内化疗，导致肿瘤缩小，从而缓解了严重的气道阻塞。这是首次使用EUS-B方法对气管肿瘤进行瘤内化疗的报告。气管肿瘤的支气管镜瘤内化疗（BITC）也是一种选择，但尚未得到充分探索，相关文献也很匮乏。
