Airway obstruction due to lymphoma of the larynx and trachea

Tracheobronchial Obstruction as a Result of Mediastinal Mass

A 21-year-old woman presented with almost complete extrinsic airway obstruction due to a massive mediastinal tumor. Venovenous extracorporeal membrane oxygenation support for 3 days with concurrent chemotherapy allowed time for tumor shrinkage, ventilation via the endotracheal route, and subsequent successful extubation on the fifth day.

Heliox in airway management

Helium-oxygen ("heliox") mixtures have been used for decades in the treatment of various respiratory problems ranging from acute upper airway obstructions to lower airway derangements, such as asthma and exacerbations of chronic bronchitis. This review presents a brief history of helium and helium-oxygen mixtures and their potential clinical uses, summarizes the results of past research into heliox in respiratory applications, explains the physiology of heliox, and presents more recent literature relating to heliox in the clinical setting.

Primary Laryngeal Lymphoma: Case Report

Extranodal laryngeal lymphoma is extremely rare. We report a case of primary laryngeal lymphoma in a 76-year-old man who had presented with a 7-week history of progressive hoarseness. Laryngoscopy revealed asymmetry of the right false vocal fold. Pathology of a deep biopsy specimen identified a malignant, diffuse, CD20-positive, B-cell lymphoma. The stage IE lymphoma completely resolved after treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and rituximab. Despite its relative rarity, the consequences of a missed diagnosis warrant vigilance for this type of laryngeal tumor.

A double-blind, randomised, controlled Phase II trial of Heliox28 gas mixture in lung cancer patients with dyspnoea on exertion

Helium has a low density and the potential of reducing the work of breathing and improving alveolar ventilation when replacing nitrogen in air. A Phase II, double-blind, randomised, prospective, controlled trial was undertaken to assess whether Heliox28 (72% He/28% O₂) compared with oxygen-enriched air (72% N₂/28% O₂) or medical air (78.9% N₂/21.1% O₂) could reduce dyspnoea and improve the exercise capability of patients with primary lung cancer and dyspnoea on exertion (Borg >3). A total of 12 patients (seven male, five female patients, age 53–78) breathed the test gases in randomised order via a facemask and inspiratory demand valve at rest and while performing 6-min walk tests. Pulse oximetry (SaO₂) was recorded continuously. Respiratory rate and dyspnoea ratings (Borg and VAS) were taken before and immediately post-walk. Breathing Heliox28 at rest significantly increased SaO₂ compared to oxygen-enriched air (96±2 cf. 94±2, P<0.01). When compared to medical air, breathing Heliox28 but not oxygen-enriched air gave a significant improvement in the exercise capability (P<0.0001), SaO₂ (P<0.05) and dyspnoea scores (VAS, P<0.05) of lung cancer patients.

Combined tracheal and esophageal stenting for palliation of tracheoesophageal symptoms from mediastinal lymphoma

Mediastinal lymphoma as a cause of tracheobronchial obstruction is uncommon, and a malignant tracheoesophageal fistula in the setting of mediastinal lymphoma is rare. Malignant tracheoesophageal fistulas are associated with pronounced morbidity and mortality. We describe a patient with mediastinal lymphomatous infiltration resulting in tracheal obstruction, esophageal obstruction, and tracheoesophageal fistula that were successfully palliated with combined airway and esophageal stent placement.

Use of heliox in critical upper airway obstruction. Physical and physiologic considerations in choosing the optimal helium:oxygen mix

Heliox has a lower density than oxygen and nitrogen, and can improve ventilation rapidly in patients with critical upper airway obstruction. The choice of the best helium:oxygen ratio depends on whether the predominant problem is hypercarbia or hypoxia. In the former situation, 80% helium should be used, and in the latter, 100% oxygen is appropriate.

Heliox improves ventilation during high-frequency oscillatory ventilation in pediatric patients

OBJECTIVE: To describe improved ventilation during high-frequency oscillatory ventilation when a nitrogen-oxygen gas mixture is replaced by a helium-oxygen gas mixture. DESIGN: Case series. SETTING: A tertiary pediatric intensive care unit. PATIENTS: Five patients with hypoxemic respiratory failure who developed persistent respiratory acidosis during treatment with high-frequency oscillatory ventilation. INTERVENTIONS: Introduction of helium-oxygen into a conventional high-frequency oscillatory ventilation circuit. MEASUREMENTS AND MAIN RESULTS: Blood gas values (pH, Pco2, and Po2) were compared in these patients during treatment with high-frequency oscillatory ventilation with nitrogen-oxygen gas flow and then for several hours after a change in treatment to helium-oxygen gas flow. An initial 24% decrease in Pco2 was documented, and an ultimate 43% decrease in Pco2 was observed. The mechanism for this improved ventilation may be related to improved gas flow properties as well as increased CO2 diffusion resulting from helium's low-mass density. Oxygenation was not adversely affected in any way. CONCLUSION: In patients with hypoxemic respiratory failure and in whom respiratory acidosis develops during high-frequency oscillatory ventilation, the use of helium-oxygen rather than nitrogen-oxygen may improve ventilation and decrease ventilator-related trauma. Further investigation is needed to validate these findings and to elucidate the mechanisms of improved ventilation.

Involvement of the larynx by hemopoietic neoplasms. An investigation of autopsy cases and review of the literature

Involvement of the larynx by hemopoietic tumors is generally considered a rare event and little is known about the associated clinicopathologic features. Laryngeal tissue removed at autopsy from 14 patients with known disseminated hematologic malignancies and at operation from one patient with multicentric malignant lymphoma of low-grade malignancy (MALToma) of the head and neck region was investigated. A systematic survey of the main clinicopathologic features of the published cases of hemopoietic tumors with laryngeal involvement was also performed. Primary involvement of the larynx by hemopoietic neoplasms must be clearly distinguished from secondary involvement by disseminated or leukemic tumors. Most of the primary tumors are localized lesions that may involve the regional lymph nodes (stages IE or IIE). Radiotherapy is the treatment of choice, and the prognosis is generally favorable. However, secondary involvement by disseminated or leukemic disease carries a very poor prognosis in most cases. Extramedullary plasmacytoma and non-Hodgkin's lymphoma (NHL), particularly B-cell lymphoma of high-grade malignancy, appear to be the most common hemopoietic tumors with primary laryngeal involvement, while primary tumors of myelogenous origin (granulocytic sarcoma and mast cell sarcoma) are extremely rare. Extramedullary plasmacytoma and NHL occur mainly in older persons and in men, are generally associated with a relatively short history of hoarseness and dysphagia, and exhibit preferential involvement of the supraglottic parts of the larynx, in particular the epiglottis and aryepiglottic folds. They are generally polypoid, non-ulcerated lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Obstructing tumors of the subglottic larynx and cervical trachea: airway management and treatment

A series of 11 patients presenting with airway obstruction secondary to tumors involving the subglottic larynx and cervical trachea was treated with either carbon dioxide or neodymium:yttrium aluminum garnet laser tumor ablation. Choice of ventilation varied according to the site of airway obstruction: Venturi jet with ventilation laryngoscope for glottic and subglottic tumors and a specially designed ventilation laser fiber tracheoscope for tumors obstructing the cervical trachea. All patients subsequently had definitive treatment of the tumor and were relieved of the compromised airway. No complications associated with ventilation and treatment techniques were recorded.