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Tuesday, March 1, 2011

TRACHEAL OBSTRUCTION

External compression by enlarged mediastinal lymph nodes containing metastatic deposits, usually from a bronchial carcinoma, is a more frequent cause of tracheal obstruction than the uncommon primary benign or malignant tumors.
Rarely the trachea may be compressed by an aneurysm of the aortic arch, or in children by tuberculous mediastinal lymph nodes. Tracheal stenosis is an occasional complication of tracheostomy, prolonged intubation or trauma.
Clinical features
Stridor can be detected in every patient with severe tracheal narrowing. Endoscopic examination of the trachea should be undertaken without delay to determine the site, degree and nature of the obstruction.
Management
Localised tumors of the trachea can be resected, but reconstruction after resection may present complex technical problems. Laser therapy and radiotherapy are alternatives to surgery. The choice of treatment depends upon the nature of the tumour and the general health of the patient. Radiotherapy or chemotherapy may temporarily relieve compression by malignant lymph nodes. Tracheal strictures can sometimes dilated but may have to be resected.


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