Tracheal Stenosis after Tracheostomy Treated Successfully with Papillotome Electrocautery
A 39-year-old woman was admitted to our Department of Cardiothoracic Surgery because of dyspnea. Twenty years previously, she underwent surgery for a diagnosed brain lesion. Since then she had taken anticonvulsant medication. The seizure attack developed after she stopped taking the anticonvulsant drug due to pregnancy. A tracheostomy was performed. Since then, dyspnea had persisted. She had no relevant family history. Physical examination revealed stridor and a wheezing sound on both lung fields. Laboratory tests were within normal range, except for decreased hemoglobin level (9.9 g/dL). Pulmonary function test indicate fixed obstructed pattern (). Flexible bronchoscopy was performed, which revealed the two-third narrowing of the upper trachea due to web-like fibrotic stenosis (). A chest computed tomography (CT) revealed diffuse stenosis and focal web at the cervical trachea (). We tried to treat the stenosis with papillotome electrocautery. The patient was discharged and followed-up in the outpatient department. After 2 weeks, we performed bronchoscopy and pulmonary function tests for follow-up. Follow-up bronchoscopy revealed persistence of mild web type stenosis. Follow-up pulmonary function test still indicated fixed obstructed pattern. So, the stenosis was again treated with the needle knife approach ().\nAfter 2 months, a flow volume curve showed a normal pattern (). Bronchoscopy revealed ulcerative lesion, but improved stenosis (). CT showed the long stenosis of the cervical trachea was decreased (). The patient has been followed-up regularly on an outpatient basis.