Management of Tracheomediastinal Fistula Using a Self-Expanding Metallic Tracheal Stent

High-Frequency Jet Ventilation for a Patient With Tracheomediastinal Fistula, Tension Pneumomediastinum, and Pneumothorax: A Case Report

Tracheomediastinal fistula (TMF) is an uncommon condition and carries a high mortality. We report the anesthetic management of a patient with TMF using stent insertion via rigid bronchoscopy. The TMF was a complication of double-lumen endotracheal tube insertion resulting in a tension pneumomediastinum. Initial intraoperative attempts to ventilate the lungs and overcome the air leak with high gas flow of 45 L/min via the side port of the bronchoscope resulted in a pneumothorax. This case report demonstrates that high-frequency jet ventilation can minimize the air leak and avoid barotrauma during anesthesia for TMF repair.

Tracheal injury characterized by subcutaneous emphysema and dyspnea after improper placement of a Sengstaken-Blakemore tube: A case report

RATIONALE

Tracheal injury characterized by subcutaneous emphysema and dyspnea can occur following the use of a Sengstaken-Blakemore tube. Should tracheal injury occur, it may be possible to manage resultant airway obstruction with a tracheal stent.

PATIENT CONCERNS

We describe the case of a 51-year-old patient who developed a tracheal injury when a Sengstaken-Blakemore tube was inadvertently inserted into the patient's trachea.

DIAGNOSES

Liver cirrhosis, gastric-fundus variceal bleeding, tracheal injury.

INTERVENTIONS

Polyglycol and tissue glue were injected intravenously, and endoscopic variceal ligation was performed. A Sengstaken-Blakemore tube was used to stop the bleeding. A covered tracheal stent was placed via fiberoptic bronchoscopy to relieve the tracheal injury due to improper placement of a Sengstaken-Blakemore tube.

OUTCOMES

After placement of the tracheal stent, the patient was able to breathe spontaneously and subsequently recovered.

LESSONS

Some precautions must be taken to avoid placing a Sengstaken-Blakemore tube in the trachea. If a tracheal injury occurs following misplacement of a Sengstaken-Blakemore tube, it may be possible to manage resultant airway obstruction by placing a tracheal stent.

Malignant tracheal necrosis and fistula formation following palliative chemoradiotherapy: a case report

Concurrent chemoradiotherapy is an essential treatment strategy for inoperable locally advanced non-small cell lung cancer (NSCLC). Although supportive care has improved, unexpected complications due to the disease or treatment can occur. Tracheomediastinal fistulas are very rare but can be a serious problem. Herein, we report a case of severe chondronecrosis of the distal trachea with formation of a fistula into a metastatic lymphadenopathy in a patient with stage IIIB NSCLC. The patient received external beam radiotherapy with a total dose of 35 Gy in 14 fractions, which was approximately half of the conventional therapeutic radiotherapy dose, along with concurrent cisplatin based chemotherapy. Careful evaluation, early detection, and timely intervention are essential to prevent and appropriately treat chondronecrosis, even in cases of low-dose radiotherapy application to central tumors.

Malignant tracheal-mediastinal-parenchymal-pleural fistula after chemoradiation plus bevacizumab: management with a Y-silicone stent inside a metallic covered stent

Tracheal or bronchial-mediastinal fistulas are a rare entity associated to high mortality. We report a case of a 58-year-old man with an unresectable non-small cell carcinoma of the lung, treated with chemoradiation followed by bevacizumab. Approximately, 6 weeks after starting bevacizumab he developed a severe cough with copious secretions He could not lie supine due to the feeling of drowning. Investigations revealed a large tracheo-mediastinal-parenchymal-pleural fistula. Palliative management was offered with interventional bronchoscopic techniques. He was found to have a large central airway defect that obliterated almost 40% of the trachea. Under general anesthesia and positive pressure ventilation, a unique approach was used to rebuild an eroded tracheal and right main stem bronchial wall. A self-expanding metallic stent (SEMS) was placed to provide a scaffold of support, whereas a Dumon Y-stent was placed inside the SEMS. This combination allowed for a patent, stable airway; recreating the normal anatomy in a minimally invasive manner walling off the fistula. The patient was discharged 2 days after the bronchoscopic intervention, with significant palliation of his symptomatology. Eighteen months later, the upper lobe cavity persists with a stable airway and stents perfectly positioned with clinically insignificant evidence of stent related granulation in the upper trachea.

Tracheomediastinal fistula in a patient with lung adenocarcinoma and its treatment with argon plasma coagulation: a case report

Tracheomediastinal fistula is a rare complication that occurs during the course of lung cancer. The fistula connects the airways to the mediastinum and is often associated with lymphoma. Clinical data on tracheomediastinal fistulas are limited to case reports. Tracheal stenting, pericardial and omental patch closure, and muscle flap closure can be performed to repair such fistulas. We herein report a case of tracheomediastinal fistula in a 47-year-old man.The main symptoms were shortness of breath and a feeling of fullness in the neck. Thoracic magnetic resonance imaging revealed an approximately 57  ×  16  ×  20 mm multiloculated cystic lesion with air density located in the upper mediastinum of the right paratracheal region and a fine fistula tract at this level. The main diagnosis was primary lung adenocarcinoma-related mediastinal lymphadenomegaly with a tracheomediastinal fistula.The patient underwent fistula opening on the trachea, which was then coagulated and sealed using argon plasma coagulation.The patient is currently asymptomatic and doing well 8 months after the intervention.