Endoscopic management of obstruction due to an acquired bronchial web

Fatal Progressive Membranous Obliterative Bronchitis: A Sequela of Influenza?

Occlusion of the bronchial orifices by tissue-like structures is an uncommonly reported finding: it has been referred to as bronchial webs, bronchial synechiae, vanishing bronchus syndrome, or membranous obliterative bronchitis. It differs from bronchiolitis obliterans, a well-described clinical entity that involves smaller airways not visualized on bronchoscopy. Although initially only recognized as a congenital condition, later reports have described it in situations where chronic inflammation results in the irritation of the airways. Here we report a case of a woman with postinfectious bronchiectasis who developed membranous occlusion of multiple subsegmental bronchi, resulting in progressive airflow obstruction and postobstructive collapse of involved lung parenchyma. This process eventually caused her demise. It the first report of membranous occlusion of the bronchi in an adult who does not have cystic fibrosis or a history of lung transplantation. Clinicians should be aware of this entity, and further research could help illuminate its pathogenesis and management.

Proliferating bronchial webs after lung transplantation

This case details the decline in lung function due to bronchial webs in a lung transplant recipient. The decline occurred 2 years after transplantation and, despite therapy, the webs, which had an inflammatory component, became treatment resistant. We outline the pathological findings and management strategies used, discuss the evidence in the literature, and offer possible causes for these unusual clinical findings.

Anesthesia for pulmonary stent insertion

PURPOSE OF REVIEW

To familiarize anesthesiologists with recent advances in endoscopic pulmonary stenting. These interventions have replaced surgical procedures for the relief of central airway obstructions.

RECENT FINDINGS

A pulmonary stent can provide immediate relief of symptoms and improvement in pulmonary function for both intrinsic and extrinsic airway lesions. The current indications for the use of both silicone-rubber stents and expandable metal stents are reviewed. Considerations for the anesthetic management of patients undergoing pulmonary stent placement are also discussed.

SUMMARY

Tracheo-bronchial stenting procedures are being employed with increasing frequency. The practicing anesthesiologist must be familiar with the management of patients undergoing airway stenting procedures.