A review on diagnostic assessments of tracheal stenosis

Tracheal stenosis (TS) is a pathological condition characterized by a reduction in the trachea diameter. It is a common complication after prolonged endotracheal intubation but may also arise from autoimmune or inflammatory processes. Clinicians can select the most appropriate treatment option based on individual patient conditions. Therefore, precise localization and evaluation of the stenosis are essential to ensure safe and effective treatment. This review summarizes current research on TS diagnosis and assessment, encompassing functional, imaging, and bronchoscopy methods. The characteristics, advantages, and disadvantages of each technique are discussed in relation to their application in the diagnosis and assessment of TS. Bronchoscopy is considered the cornerstone of TS diagnosis, and novel adjunct imaging modalities have emerged to enhance its accuracy. We explore advanced endomicroscopic methods, such as endobronchial ultrasound (EBUS), photoacoustic endoscopy (PAE), optical coherence tomography (OCT), and confocal laser endomicroscopy (CLE). Among these, EBUS is clinically approved for diagnosing lesions with high resolution and acceptable penetration depth. OCT and CLE offer real-time imaging for peripheral lesions and potentially malignant nodules, but their use is limited by cost and availability in low-resource settings. Therefore, bronchoscopy, with biopsy techniques as needed, remains the optimal approach for diagnosing tracheal stenosis.

Endobronchial optical coherence tomography helps to estimate the cartilage damage of the central airway in TBTB patients

Purpose

At present, there are few examination methods used to evaluate tracheobronchial cartilage damage. In our study, we explored whether endobronchial optical coherence tomography (EB-OCT) can be used to estimate central airway cartilage damage in tracheobronchial tuberculosis (TBTB) patients.

Methods

In our study, we used the OCTICS Imaging system to perform EB-OCT scanning for TBTB patients. The thickness of the central airway wall and cartilage was measured by the OCTICS software system workstation.

Results

There were 102 TBTB patients included in our study cohort. Their EB-OCT images of the central airway cartilage showed that abnormal cartilage manifests as thinning of the cartilage, cartilage damage, cartilage destruction, and even cartilage deficiency. The cartilage morphology becomes irregular and discontinuous. Some parts of the cartilage become brighter in grayscale. The intima of the cartilage is thickened and discontinuous, and the boundary with submucosa and mucosa is unclear.

Conclusion

Our study conducted EB-OCT examination of the central airway cartilage of TBTB patients in vivo for the first time. EB-OCT helps to estimate the cartilage damage of the central airway in TBTB patients to some extent.

Investigations on the potential of optical coherence tomography as an imaging tool for eustachian tube

The purpose of this study was to explore the feasibility of eustachian tube optical coherence tomography (ET-OCT) for imaging the pharyngeal region of the eustachian tube (ET). Ten subjects with ear complaints underwent ET-OCT guided by nasal endoscopy, and ET-OCT examination was performed on both sides of each subject's ETs. The process and resulting images were analysed. Ten subjects ranging from 21 to 73 years old (45 ± 14.77) were enrolled in this study. Eighteen ET-OCT imaging examinations were completed. The mean duration of each examination was 2.80 ± 1.62 min (ranging from 2 to 7 min). There were no adverse events or complications. In some subjects, the ET-OCT images clearly presented the microstructures of the ET wall, including the lumen, mucosa, submucosa, cartilage and plica. However, in some subjects, it showed different characteristics, such as an unclear hierarchy and secretions in the lumen. ET-OCT may help to distinguish the structural composition of the ET and elucidate related pathophysiological mechanisms. It is a valuable imaging tool suited for the ET, with potential diagnostic value in determining the morphology of the lumen, intraluminal mucosa and submucosal tissue in the pharyngeal region of the ET.

Anesthetic consideration for airway management in patient undergoing tracheal resection and reconstruction for severe postintubation tracheal stenosis: a case report

Introduction Severe postintubation tracheal stenosis (PITS) is a rare iatrogenic complication after endotracheal intubation.Case presentation A case of PITS in a 51-year-old male undergoing partial pericardiectomy with a principal diagnosis of tuberculous constrictive pericarditis. Within 6 hours of extubation, a second emergency intubation lasting 120 hours was performed. The patient reported exertional dyspnea 30 days after discharge. High-resolution tracheobronchial tree computed tomography with three-dimensional reconstruction revealed constriction of the tracheal lumen of more than 80% at the thyroid planar upper third of the trachea. Flexible bronchoscopy revealed a tracheal stenosis located 3-4 cm from the glottis that could not be passed prior to general anesthesia. Mechanical ventilation with a ProSeal laryngeal mask airway (PLMA) and preparation for extracorporeal circulation as a final rescue option were performed to maximize patient safety. The patient underwent a tracheal resection and reconstruction without complications.Conclusion A supraglottic airway mode may be a practical and worthwhile alternative for patients with severe PITS.