[Etiological diagnosis and treatment of central airway obstruction: report of 40 cases and review of the literature]

Wei Zhao, Zhen Yang, Liang-an Chen
Chinese Journal of Tuberculosis and Respiratory Diseases 2011, 34 (8): 590-4

OBJECTIVE: To explore the etiology, clinical features, diagnosis and treatment of central airway obstruction (CAO), and therefore to raise awareness of this disease.

METHODS: Forty patients with central airway obstruction were analyzed retrospectively and their clinical characteristics were described.

RESULTS: Among these 40 cases of CAO, the diagnoses included squamous cell carcinoma (n = 13), adenoid cysts (n = 5), esophageal squamous cell carcinoma (n = 4), and benign tumor (n = 6). The presenting symptoms included cough (n = 36), shortness of breath or difficulty breathing (n = 21), and hemoptysis or bloody sputum which was more common in cases with airway squamous cell carcinoma (n = 11). All the patients underwent chest CT examination, and the lesions were evident in all the cases. Twenty-one cases underwent three-dimensional reconstruction of the airway. Six patients underwent pulmonary function test, and ventilatory abnormalities were revealed, and showed the characteristic blunting of the flow-volume loop. Thirty-nine cases underwent bronchoscopy and correct clinical diagnosis was made. Eleven patients received interventional therapy with argon plasma coagulation (APC), and their symptoms were all relieved within 2 days.

CONCLUSIONS: CAO may be caused by variety of diseases, but the most common cause is malignancy. The common symptoms of CAO are cough and dyspnea. Chest CT with airway reconstruction, bronchoscopy and pathological examination can provide accurate information for diagnosis. The choice of treatment modalities depends on the size, location and the pathology of the lesions. APC is a safe and effective therapy for short-term management of malignant lesions.

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