1
|
Ng KL, Tan SN, Huan N, Nasaruddin MZ, Othman N, Rahaman JAA. Utilizing medical thoracoscopy for the diagnosis of myelomatous pleural effusion: 2 case reports. Respirol Case Rep 2024; 12:e01333. [PMID: 38528948 PMCID: PMC10963134 DOI: 10.1002/rcr2.1333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
Multiple myeloma (MM) is characterized by neoplastic proliferation of monoclonal antibody producing plasma cells. In clinical practice, pleural effusion is seen in up to 6% of MM patients, with many causative factors. Nevertheless, true myelomatous pleural effusion, defined as infiltration of the pleura by myeloma cells, is very rare. In this case report, we present two patients with biopsy proven myelomatous pleural effusion. The first patient developed myelomatous pleural effusion as initial presentation while the second patient's pleural effusion occurred during disease relapse. In both cases, prompt diagnosis via medical thoracoscopy (MT) followed by early commencement of myeloma specific chemotherapy led to clinical, biochemical, and radiological resolution and therefore were crucial steps in the management of myelomatous pleural effusion.
Collapse
Affiliation(s)
- Khai Lip Ng
- Department of MedicineMelaka HospitalMelakaMalaysia
- Department of PulmonologySerdang HospitalKajangMalaysia
| | - Sin Nee Tan
- Department of PulmonologySerdang HospitalKajangMalaysia
| | - Nai‐Chien Huan
- Department of Respiratory MedicineQueen Elizabeth HospitalKota KinabaluMalaysia
| | | | - Noriah Othman
- Department of PathologySerdang HospitalKajangMalaysia
| | | |
Collapse
|
2
|
Soo CI, Mak WW, Nasaruddin MZ, Ismail R, Ban AYL, Abdul Rahaman JA. Bronchial thermoplasty for severe asthmatics: a real-world clinical study from Malaysia. Singapore Med J 2024; 65:119-122. [PMID: 34617697 PMCID: PMC10942133 DOI: 10.11622/smedj.2021144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Chun Ian Soo
- Division of Respiratory Medicine, Department of Internal Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Woh Wei Mak
- Department of Pulmonology, Serdang Hospital, Selangor, Malaysia
| | | | - Rosmadi Ismail
- Department of Pulmonology, Serdang Hospital, Selangor, Malaysia
| | - Andrea Yu-Lin Ban
- Pulmonology Unit, Department of Internal Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | |
Collapse
|
3
|
Daut UN, Faisal Thena MH, Hui‐Xin T, Nasaruddin MZ, Abdul Rahaman JA. Inflammatory endobronchial polyps unleashing recurrent pneumothorax: A case report. Respirol Case Rep 2024; 12:e01278. [PMID: 38239333 PMCID: PMC10794854 DOI: 10.1002/rcr2.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 01/22/2024] Open
Abstract
Inflammatory endobronchial polyps (IEPs) are rare benign lesions that originate from the bronchial mucosa. While pneumothorax is a well-known complication of various pulmonary conditions, its association with IEPs is exceedingly uncommon and poorly understood. This case report presents a unique and explosive encounter of a patient with an inflammatory endobronchial polyp who experienced a pneumothorax, shedding light on the clinical presentation, diagnostic challenges, and management strategies for this rare entity.
Collapse
Affiliation(s)
| | | | - Tan Hui‐Xin
- Pulmonology DepartmentHospital Sultan Idris Shah SerdangSerdangMalaysia
| | | | | |
Collapse
|
4
|
Lourdesamy Anthony AI, Satnam Singh TK, Ng KL, Abdul Rahaman JA. Endotracheal inflammatory myofibroblastic tumour: A rare cause of central airway occlusion in adults. Respirol Case Rep 2022; 10:e0984. [PMID: 35702693 PMCID: PMC9174595 DOI: 10.1002/rcr2.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Inflammatory myofibroblastic tumour (IMT) is an unusual myofibroblastic spindle cell neoplasm that is rarely discovered in the airway of adults. Previously, it was regarded as a reactive lesion and was infamously known as inflammatory pseudotumour before recent insights revealed that significant majority of cases harboured neoplastic genes. Diagnosis is difficult as clinical presentation and imaging findings are non‐specific. Diagnosis and a favourable prognosis require the complete resection of the tumour. Detection of the anaplastic lymphoma kinase expression via immunohistochemistry expedites diagnosis. We report a young adult with an endotracheal mass occluding the central airway. The patient successfully underwent bronchoscopic resection using interventional techniques. IMT was diagnosed. No recurrence was seen after a year of surveillance. Due to the rarity of the disease, the recurrence rates for large airway disease is unknown. Recurrence rates for pulmonary lesions is reported to be lower compared to extrapulmonary IMTs and recurrence is unlikely if compete surgical excision is achieved.
Collapse
Affiliation(s)
| | | | - Khai Lip Ng
- Department of Medicine Hospital Melaka Melaka Malaysia
| | | |
Collapse
|
5
|
Kho SS, Soo CI, Nasaruddin MZ, Ngan KW, Abdul Rahaman JA. Multimodal linear endobronchial ultrasound guided mediastinal lymph node biopsy in the diagnosis of isolated mediastinal lymphadenopathy. Proceedings of Singapore Healthcare 2022. [DOI: 10.1177/20101058221111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Isolated mediastinal lymphadenopathy represents a common diagnostic dilemma whereby morphological analysis of tissue specimens are frequently needed to ascertain the diagnosis. Cryobiopsy by linear endobronchial ultrasound (EBUS) guidance had recently been described in literature. We described a multimodality biopsy approach of a case of isolated tuberculous mediastinal lymphadenitis in which we employed the 22-gauge transbronchial aspiration needle, mini-forceps and a flexible cryoprobe sequentially. We aim to highlight the novel technique of linear EBUS guided cryobiopsy in acquiring superior histological specimen from mediastinal lymphadenopathy for diagnosis purposes. We also compared the histopathological quality of the specimens acquired from these three different biopsy modalities.
Collapse
Affiliation(s)
- Sze Shyang Kho
- Pulmonology Department, Serdang Hospital, Ministry of Health Malaysia, Selangor, Malaysia
- Division of Respiratory Medicine, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Sarawak, Malaysia
| | - Chun Ian Soo
- Division of Respiratory Medicine, Department of Internal Medicine, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Mona Zaria Nasaruddin
- Pulmonology Department, Serdang Hospital, Ministry of Health Malaysia, Selangor, Malaysia
| | - Kah Wai Ngan
- Pathology Department, Serdang Hospital, Ministry of Health Malaysia, Selangor, Malaysia
| | | |
Collapse
|
6
|
Kho SS, Nasaruddin MZ, Rahaman JAA. Virtual Bronchoscopic Navigation Guided Recanalization of Chronic Total Post-Tuberculosis Bronchial Stenosis. Arch Bronconeumol 2022; 58:768-769. [DOI: 10.1016/j.arbres.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 12/01/2022]
|
7
|
Kho SS, Ganapaty S, Omar N, Tan SZ, Nasarudin MZ, Abdul Rahaman JA. Opportunistic actinomycosis in pulmonary alveolar proteinosis. Thorax 2022; 77:842-843. [PMID: 35304426 DOI: 10.1136/thoraxjnl-2021-217940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Sze Shyang Kho
- Department of Pulmonology, Serdang Hospital, Kajang, Selangor, Malaysia .,Division of Respiratory Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | | | - Noorjehan Omar
- Department of Pathology, Serdang Hospital, Kajang, Selangor, Malaysia
| | - Shang Ze Tan
- Department of Medicine, Hospital Ampang, Ampang, Malaysia
| | | | | |
Collapse
|
8
|
Kho SS, Nyanti LE, Muhammad NA, Nasaruddin MZ, Abdul Rahaman JA. The more you give, the worse it gets. Breathe (Sheff) 2022; 17:210083. [PMID: 35035553 PMCID: PMC8753619 DOI: 10.1183/20734735.0083-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/04/2021] [Indexed: 11/05/2022] Open
Abstract
Persistent tachypnoea despite resolution of bronchospasm in a patient with acute asthma exacerbation after administration of inhaled short acting β2-receptor agonist should alert the clinician to this potential diagnosis. https://bit.ly/385VU2Q.
Collapse
Affiliation(s)
- Sze Shyang Kho
- Pulmonology Unit, Serdang Hospital, Ministry of Health Malaysia, Selangor, Malaysia.,Division of Respiratory Medicine, Dept of Internal Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Sarawak, Malaysia
| | - Larry Ellee Nyanti
- Division of Respiratory Medicine, Dept of Internal Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Sarawak, Malaysia
| | | | | | | |
Collapse
|
9
|
Yong YV, Mahamad Dom SH, Ahmad Sa'ad N, Lajis R, Md Yusof FA, Abdul Rahaman JA. Development and Practical Application of a Multiple-Criteria Decision Analysis Framework on Respiratory Inhalers: Is It Always Useful in the MOH Malaysia Medicines Formulary Listing Context? MDM Policy Pract 2021; 6:2381468321994063. [PMID: 33855190 PMCID: PMC8013673 DOI: 10.1177/2381468321994063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives. The current health technology assessment used to evaluate respiratory inhalers is associated with limitations that have necessitated the development of an explicit formulary decision-making framework to ensure balance between the accessibility, value, and affordability of medicines. This study aimed to develop a multiple-criteria decision analysis (MCDA) framework, apply the framework to potential and currently listed respiratory inhalers in the Ministry of Health Medicines Formulary (MOHMF), and analyze the impacts of applying the outputs, from the perspective of listing and delisting medicines in the formulary. Methods. The overall methodology of the framework development adhered to the recommendations of the ISPOR MCDA Emerging Good Practices Task Force. The MCDA framework was developed using Microsoft Excel 2010 and involved all relevant stakeholders. The framework was then applied to 27 medicines, based on data gathered from the highest levels of available published evidence, pharmaceutical companies, and professional opinions. The performance scores were analyzed using the additive model. The end values were then deliberated by an expert committee. Results. A total of eight main criteria and seven subcriteria were determined by the stakeholders. The economic criterion was weighted at 30%. Among the noneconomic criteria, "patient suitability" was weighted the highest. Based on the MCDA outputs, the expert committee recommended one potential medicine (out of three; 33%) be added to the MOHMF and one existing medicine (out of 24; 4%) be removed/delisted from the MOHMF. The other existing medicines remained unchanged. Conclusions. Although this framework was useful for deciding to add new medicines to the formulary, it appears to be less functional and impactful for the removal/delisting existing medicines from the MOHMF. The generalizability of this conclusion to other formulations remains to be confirmed.
Collapse
Affiliation(s)
- Yee Vern Yong
- Pharmacy Practice & Development Division, Ministry of Health Malaysia
| | | | | | - Rosliza Lajis
- National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia
| | | | - Jamalul Azizi Abdul Rahaman
- Former Head of Therapeutic Drug Working Committee (TDWC) Respiratory (2014-2020), Serdang Hospital, Ministry of Health Malaysia
| |
Collapse
|
10
|
Huan N, Ng KL, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA. Topical mitomycin-C as an adjuvant to multimodal endoscopic treatment for tracheobronchial stenosis secondary to endobronchial tuberculosis. Respirol Case Rep 2021; 9:e00711. [PMID: 33532074 PMCID: PMC7829630 DOI: 10.1002/rcr2.711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 12/02/2022] Open
Abstract
Tracheobronchial stenosis secondary to endobronchial tuberculosis (TSTB) is a rare but debilitating complication of endobronchial tuberculosis (EBTB). Topical mitomycin-C (TMC) has been successfully utilized to restore airway patency and to prevent recurrence of TSTB, although little is known about its exact efficacy. Here, we report the biggest case series to date involving seven patients who received TMC as part of multimodality endoscopic treatment for TSTB with varying levels of success. All patients presented with dyspnoea during or after treatment completion for pulmonary tuberculosis (PTB). Four patients had short-segment concentric membranous TSTB while two patients had concurrent bronchomalacia. Another one patient had a thick fibrotic band adjacent to luminal opening. We hypothesize that TMC is more efficacious in short membranous stenosis without concurrent bronchomalacia and/or thick fibrotic bands. More studies are needed to bridge the current gaps in knowledge regarding the optimal role and benefits of TMC for TSTB patients.
Collapse
Affiliation(s)
| | - Khai Lip Ng
- Department of PulmonologySerdang HospitalKajangMalaysia
| | | | | | | | | |
Collapse
|
11
|
Ng BH, Mohd Aminudin NH, Nasaruddin MZ, Abdul Rahaman JA. Successful drainage of complex haemoserous malignant pleural effusion with a single modified low-dose intrapleural alteplase and dornase alfa. BMJ Case Rep 2021; 14:14/2/e239702. [PMID: 33547099 PMCID: PMC7871233 DOI: 10.1136/bcr-2020-239702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with symptomatic complex malignant pleural effusion (MPE) are frequently unfit for decortication and have a poorer prognosis. Septations can develop in MPE, which may lead to failure of complete drainage and pleural infection. Intrapleural fibrinolytic therapy (IPFT) is an alternative treatment. The use of IPFT in patients with anaemia and high risk for intrapleural bleeding is not well established. We report a successful drainage of complex haemoserous MPE with a single modified low-dose of intrapleural 5 mg of alteplase and 5 mg of dornase alfa in a patient with pre-existing anaemia with no significant risk of intrapleural bleeding.
Collapse
Affiliation(s)
- Boon Hau Ng
- Medical Department, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | | | | |
Collapse
|
12
|
Ng KL, Huan N, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA. Pulmonary mucormycosis masquerading as endobronchial tumour in an immunocompetent pregnant young lady. Respirol Case Rep 2021; 9:e00704. [PMID: 33364028 PMCID: PMC7756165 DOI: 10.1002/rcr2.704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/11/2022] Open
Abstract
Pulmonary mucormycosis is a rare but rapidly progressing and life-threatening fungal infection, usually affecting immunocompromised patients. We report a case of a previously healthy young lady who presented with prolonged cough, weight loss, and haemoptysis. Imaging showed left hilar mass with infiltration into the left main bronchus and concurrent mediastinal lymphadenopathy. Flexible bronchoscopy revealed an endobronchial mass occluding the left main bronchus. Tumour debulking was performed using rigid bronchoscopy with cryoprobe and snares. Histopathological examination revealed inflamed tissue with fungal organism. Fungal polymerase chain reaction (PCR) confirmed Rhizopus microsporus. She was treated with two weeks of intravenous amphotericin-B with complete clinical and radiological resolution.
Collapse
Affiliation(s)
- Khai Lip Ng
- Department of PulmonologySerdang HospitalKajangMalaysia
| | | | | | | | | | | |
Collapse
|
13
|
Mohd Esa NY, Faisal M, Vengadesa Pilla S, Abdul Rahaman JA. Silicone Y-stent insertion under extracorporeal membrane oxygenation (ECMO) in a patient with tracheal tear. BMJ Case Rep 2020; 13:13/12/e236414. [PMID: 33370965 PMCID: PMC7757493 DOI: 10.1136/bcr-2020-236414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.
Collapse
Affiliation(s)
| | - Mohamed Faisal
- Respiratory, National University of Malaysia Faculty of Medicine, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
14
|
Huan N, Ng KL, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA. Conservative management of airway tear as a complication of silicone endobronchial stenting in bronchomalacia secondary to endobronchial tuberculosis. Respirol Case Rep 2020; 8:e00684. [PMID: 33194207 PMCID: PMC7644387 DOI: 10.1002/rcr2.684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 11/12/2022] Open
Abstract
Tracheobronchial stenosis due to tuberculosis (TSTB) is a potentially debilitating complication of endobronchial tuberculosis (EBTB). Endobronchial interventions including silicone stent insertion is an acceptable approach to improve quality of life among patients with TSTB. However, little is known about the optimal management strategy for patients with bronchomalacia secondary to EBTB (B-EBTB) and whether stent-related complication rates are higher among this group of patients. Herein, we report two patients with B-EBTB who unfortunately developed bronchial tear related to silicone endobronchial stenting. Both patients were successfully managed conservatively without the need for emergency open surgery. We hypothesize that endobronchial intervention might be more beneficial for patients with pure TSTB and might be riskier in cases of bronchomalacia with reduced airway thickness and loss of airway cartilaginous support. More future studies are needed to bridge the current gap in knowledge regarding the optimal management and role of endobronchial interventions among patients with B-EBTB.
Collapse
Affiliation(s)
| | - Khai Lip Ng
- Department of PulmonologySerdang HospitalKajangMalaysia
| | | | | | | | | |
Collapse
|
15
|
Hanif Khan A, Faisal M, Mohd Ali R, Abdul Rahaman JA. Resolution of asthmatic symptoms following successful endoscopic resection of tracheal mucoepidermoid carcinoma. BMJ Case Rep 2019; 12:12/1/e226202. [PMID: 30659001 PMCID: PMC6340577 DOI: 10.1136/bcr-2018-226202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) is a rare tumour of the trachea accounting for up to 0.2% of reported primary lung malignancy. We report a case of a 54-year-old man, ex-smoker, whose presentation mimicked adult onset asthma with cough and wheezing, which did not respond to conventional treatment. He had occasional haemoptysis and weight loss in which CT scan performed for malignancy screening showed a protruding mass in the distal trachea causing endobronchial obstruction. Bronchoscopic intervention was performed to relieve the obstruction that resulted in resolution of asthmatic symptoms. Histological diagnosis confirmed MEC. This case emphasised the importance of a high index of suspicion in an unusual presentation of a common disease and the pivotal role of bronchoscopic intervention in malignant central airway obstruction.
Collapse
Affiliation(s)
- Abdul Hanif Khan
- Department of Medicine, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Selangor, Malaysia
| | - Mohamed Faisal
- Department of Respiratory, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Razana Mohd Ali
- Department of Pathology, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Selangor, Malaysia
| | | |
Collapse
|
16
|
Faisal M, Harun H, Hassan TM, Ban AYL, Chotirmall SH, Abdul Rahaman JA. Treatment of multiple-level tracheobronchial stenosis secondary to endobronchial tuberculosis using bronchoscopic balloon dilatation with topical mitomycin-C. BMC Pulm Med 2016; 16:53. [PMID: 27080697 PMCID: PMC4832514 DOI: 10.1186/s12890-016-0209-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tracheobronchial stenosis is a known complication of endobronchial tuberculosis. Despite antituberculous and steroid therapy, the development of bronchial stenosis is usually irreversible and requires airway patency to be restored by either bronchoscopic or surgical interventions. We report the use of balloon dilatation and topical mitomycin-C to successful restore airway patency. CASE PRESENTATION We present a 24-year old lady with previous pulmonary tuberculosis and laryngeal tuberculosis in 2007 and 2013 respectively who presented with worsening dyspnoea and stridor. She had total left lung collapse with stenosis of both the upper trachea and left main bronchus. She underwent successful bronchoscopic balloon and manual rigid tube dilatation with topical mitomycin-C application over the stenotic tracheal segment. A second bronchoscopic intervention was performed after 20 weeks for the left main bronchus stenosis with serial balloon dilatation and topical mitomycin-C application. These interventions led to significant clinical and radiographic improvements. CONCLUSION This case highlights that balloon dilatation and topical mitomycin-C application should be considered in selected patients with tracheobronchial stenosis following endobronchial tuberculosis, avoiding airway stenting and invasive surgical intervention.
Collapse
Affiliation(s)
- Mohamed Faisal
- Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Hafaruzi Harun
- Respiratory Unit, Serdang Hospital, Jalan Puchong, 43000, Kajang, Selangor Darul Ehsan, Malaysia
| | - Tidi M Hassan
- Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Andrea Y L Ban
- Department of Medicine, Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | |
Collapse
|