Complete bronchial stricture and airway management challenges

Abstract 

Objective

The purpose of this report is to demonstrate a unique case of severe bronchial stricture and discuss the associated diagnostic and airway management challenges.

Study design

The design was that of a case report.

Methods

A review of the literature was made.

Results

A 15-year-old adolescent boy with a history of renal transplantation 1 year prior presented with a 10-day history of progressive cough and shortness of breath necessitating ventilator support. Chest radiograph and computed tomography showed complete whiteout of the left lung with some areas of hyperinflation of the left upper lobe. Subsequent flexible and rigid bronchoscopy noted a narrowed left mainstem bronchus with no evidence of an intact lumen. After failed attempts at medical treatment and dilation, the patient underwent a left pneumonectomy. He was ultimately discharged home in good condition.

Discussion

Bronchial strictures are rare phenomenon with oftentimes unclear etiologies. Atresia of bronchi is even rarer, usually occurring in young males, and may go undiagnosed for 30 years until clinical symptoms occur. Treatment of narrowed segments may involve medical treatment of infectious agents, stent placement, dilation, and sleeve resection. Treatment of atresia or severe stricture may necessitate resection of the lung distal to the affected region.

Conclusion

Bronchial strictures and atresias may go undiagnosed for years before pulmonary symptoms occur. Computed tomography and bronchoscopy with biopsies represent the mainstays of diagnosis. Regional lung hyperinflation and peribronchial translucency may hint at bronchial atresia. Treatment paradigms vary from dilation and stent placement to resection of the affected areas. In the absence of a clear etiology for lung whiteout, severe bronchial stricture or atresia should be considered as a possibility.