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Overview of Diseases of the Airway

By Michael Zervos, M.D.

Diseases of the airway can cause severe shortness of breath, coughing, bleeding, and can even be classified as surgical emergencies in some instances. NYU Medical Center's specially trained experts diagnose and manage these conditions, whether they are benign or malignant.

Benign Diseases

Post-intubation Tracheal Stenosis: A narrowing of the trachea or windpipe caused by prolonged mechanical ventilation. Generally occurs after a prolonged period on a breathing machine or a tracheotomy. The most common symptom is difficult or noisy breathing. Up to 20% of cases are diagnosed by endoscopy, while others are determined clinically or by chest X-ray, CT scan, or bronchoscopy. Some form of intervention, either surgical or non-surgical, is required.

Tracheobronchomalacia: A loss of rigidity of the trachea and bronchi, commonly referred to as airway collapse or weakness, that generally occurs while exhaling. The most common symptom is difficulty breathing or a shortness of breath. Clinically diagnosed with a dynamic CT scan or bronchoscopy , and treated with endoscopic stent placement or surgery.

Benign Tumors of the Trachea and Bronchi: Non-cancerous lesions, including hamartoma, adenomas, chondromas, leiomyomas and papillomas, that can cause symptoms of obstruction, recurrent infection, pneumonia, and bleeding. Benign carcinoid tumors have the potential to become cancer or can be an intermediate form of cancer and may need further treatment. Clinically diagnosed by CT scan or bronchoscopy, tumors are removed through endoscopy or surgery.

Trauma to the Trachea and Bronchi: A result of either direct force or an automotive deceleration injury. The most common symptom is difficult or noisy breathing. Immediate attention in an emergency room setting is required to determine the extent of the injury and to secure the airway. Treatment involves some form of laryngoscopy , bronchoscopy , possible cricothyroidotomy and some form of surgery.

Tracheoesophageal Fistula: A connection between the trachea and esophagus that can be caused by a prolonged period on a breathing machine or a tracheotomy. Treatment is performed through a neck incision and includes tracheal resection, closure of the esophageal defect and placement of a muscle flap between the two structures.

Tracheoinnominate Fistula: A life-threatening connection between the trachea and innominate artery that requires immediate attention. Surgery is done through the breastbone (sternotomy) to separate the two structures, control the artery, and repair the hole in the trachea. If necessary, a muscle flap may be used to help seal the trachea and keep it separated from the artery.

Malignant Diseases

Primary Tracheal Tumors: A rare form of cancer that originates from the trachea or bronchial tissues in either squamous cell carcinoma (link) or adenoid cystic carcinoma (link) form. Other forms include adenocarcinoma, adenosquamous, small cell, carcinoid tumor, mucoepidermoid, spindle cell sarcoma, and malignant fibrous histiocytoma. The tumors generally occur in 50- and 60-year-olds with symptoms of progressive difficulty breathing and bleeding. Tumors are diagnosed by bronchoscopy and a positive biopsy, and their extent is determined by CT scan. Preferred treatment is surgery, endoscopic resection, and radiation therapy, while non-surgical options include local therapies such photodynamic therapy, laser, cryoablation, argon plasma coagulator, cautery, and stenting. Chemotherapy does not work for these tumors.

Metastatic Tumors of the Trachea and Bronchi: Tumors that originate elsewhere, but involve the trachea and bronchi secondarily, including lung cancers, laryngeal cancer, thyroid cancer, or mediastinal cancer like thymic carcinoma, melanoma, and cancers from the colon, breast, kidney, ovaries and endometrium. The main symptoms are progressive worsening of breathing and coughing up blood (hemoptysis). Tumors are diagnosed by bronchoscopy and a positive biopsy. Treatment can be performed with either flexible or rigid bronchoscopy or involve alternatives such as photodynamic therapy, laser treatments, argon plasma coagulation, cautery, forceps and tracheobronchial stenting.

Malignant Tracheoesophageal Fistula: A connection formed between the trachea or any part of the airway and the esophagus, caused by esophageal cancer. Common symptoms include coughing up blood (hemoptysis) or obstruction. Malignant tracheoesophageal fistula is diagnosed by bronchoscopy with biopsy or can be demonstrated by CT scan and esophagram. Treatment involves bronchoscopy , resection, laser, and stenting.

Malignant Airway Obstruction: An obstruction of the trachea and bronchi caused by tumors close to the airway or associated by distant metastatic involvement, most commonly lung and esophageal cancers. The most common symptoms are coughing up blood (hemoptysis) and progressive shortness of breath. Diagnosis is confirmed with bronchoscopy and positive biopsy, while a CT scan determines if it is primary tumor involvement or lymph node erosion. Treatment options, which can only improve local symptoms, include laser, photodynamic therapy (PDT) , cautery, argon plasma coagulation, forceps, and stenting.