| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2000;69:1985
© 2000 The Society of Thoracic Surgeons
a Second Department of Surgery, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
b Department of Radiology Kagoshima University Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
e-mail: simokawa{at}med6.kufm.kagoshima-u.ac.jp
To the Editor
We read with interest the article by Schmidt and associates [1]. We congratulate the authors on successful treatment of airway stenoses due to malignant lymphoma by temporary tracheobronchial stenting followed by tumor-specific therapy. The authors stated that airway stenosis in malignant mediastinal lymphoma is mainly due to extraluminal compression, which makes stenting the treatment of choice. However, other treatment may be required in case of central airway infiltration of the tumor [2].
We have experienced such a rare case in July 1996. A 15-year-old girl suddenly presented with severe dyspnea along with complete atelectasis of the left lung. She was intubated for 2 days and referred to the Department of Radiology of our hospital for further examination 3 days later. Computed tomographic scans showed a subcarinal tumor infiltrating the left main bronchus and extending to the carina, without other abnormalities. Four days later, she was reintubated due to recurrent severe dyspnea. Fiberoptic bronchoscopy disclosed a tumor almost occupying the carina. Tumor biopsy was not performed because of its abundant vascularity. The dyspnea did not improve by mechanical ventilation. Tracheobronchial stenting or laser ablation seemed to be contraindicated because of tumor fragility and its abundant vascularity. At midnight, the radiologists asked us to perform an emergent operation. After right anterolateral throracotomy, partial cardiopulmonary bypass was established between the right femoral artery and both vena cavae. Dissection of the carina was impossible because of the hard infiltrating subcarinal tumor. A transverse incision was made at the right side of the distal trachea. The polypoid tumor approximately 1.8 cm in diameter, arising from the pars membranacea of the left main bronchus and extending to the carina, was removed. Considering her age and suspicious diagnosis of malignant lymphoma, further operative procedure was not performed. Cardiopulmonary bypass provided adequate oxygenation during the operation. She was easily weaned from cardiopulmonary bypass. The bypass time was 103 minutes. The postoperative course was uneventful. She was extubated on the fifth postoperative day. The pathological diagnosis was anaplastic large cell lymphoma. Irradiation was initiated (10 x 2 Gy) 13 days after operation. Thereafter, she received a combination chemotherapy regimen comprising CHOP. She is well at 40 months of follow-up, without evidence of tumor recurrence.
In our case, an emergent operation was required for the imminent respiratory failure before obtaining the confirmed diagnosis. Cardiopulmonary bypass is useful in major airway operations when adequate oxygenation can not be accomplished by conventional techniques, especially in patients with acute respiratory distress [3]. Temporary tracheobronchial stenting is effective in the management of symptomatic airway stenoses due to not only malignant lymphoma but also thoracic aortic aneurysm [4]. If the life-threatening respiratory failure is treated by temporary airway stenting or palliative operation, malignant lymphoma is possible to be cured by tumor-specific treatment in selected cases.
References
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
