Bronchoscopic management of tracheal obstruction due to thyroid cancer: case series
BA. Arnur*a (Mrs), M. Elhidsia (Dr), SL. Andarinia (Dr), D. Soehardimana (Dr), R. Begintab (Dr)
a Universitas Indonesia - Persahabatan Hospital, Jakarta, INDONESIA ; b Persahabatan Hospital, Jakarta, INDONESIA
Background: Papillary thyroid carcinoma (PTC) is usually associated with favorable survival. Tracheal invasion is a poor prognostic factor due to central airway obstruction (CAO). The incidence of tracheal invasion secondary to thyroid carcinoma is 35-60%. We performed a bronchoscopy on two male patients with CAO who presented stridor due to PTC.
Case report: Case 1, a 50-years-old male patient with PTC. Bronchoscopy showed mass above the vocal cords and completely covers the proximal trachea to mid-trachea. The mass was removed by a laser, cryoablation, and argon-plasma coagulation through the rigid bronchoscope. The next procedure was thyroidectomy. Following thyroidectomy, there was stridor again. We performed an emergency bronchoscopy that showed an infiltrative mass near the carina. It was removed by laser and cryoablation followed by a Y stent implanted. Bronchoscopy evaluation six months later showed compression stenosis of the vocal cord and infiltrative granulation mass partially covering the distal stent. Triamcinolone was injected into the granulation mass, followed by Y stent removal and tracheostomy. Case 2, a 46-years-old male patient with PTC. We did an emergency tracheostomy followed by bronchoscopy with a fiber optic bronchoscope which showed an infiltrative subglottic mass that was almost completely closed the upper airway. This patient was scheduled for thyroidectomy, tracheostomy decannulation followed by cryoablation bronchoscopy.
Conclusion: bronchoscopy is the treatment of choice for CAO due to PTC. Rigid bronchoscope and fiber optic bronchoscope, laser, cryoablation, argon-plasma coagulation, and airway stent are modalities in bronchoscopy that can be performed based on patient performance status and type of obstruction.
Disclosure of funding source(s): none