Highlights & Basics
- Central airway obstruction (CAO) commonly presents with nonspecific symptoms including dyspnea, cough, and wheeze. Patients may be misdiagnosed with other airway diseases. A high degree of suspicion is necessary to ascertain the diagnosis.
- In severe obstruction presenting with impending respiratory failure, immediate attention must be given to securing the airway. Rigid bronchoscopy is the procedure of choice, providing capacity for both diagnostic and therapeutic airway intervention.
- Definitive confirmation of CAO requires diagnostic bronchoscopy diagnostic bronchoscopy (flexible or rigid). Imaging of the chest with plain x-rays and computed tomography, as well as pulmonary function tests, are useful ancillary investigations.
- A multidisciplinary approach to management, involving a pulmonologist, otolaryngologist, thoracic surgeon, thoracic radiologist, and interventional bronchoscopist, is key to improved patient outcomes.
- The distinction between malignant and nonmalignant CAO is important. If malignancy is suspected or confirmed, the opinion of an oncologist and radiation oncologist should be sought following any immediate stabilization of the airway.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Types of central airway obstruction: intrinsic, extrinsic, and mixed
Central airway obstruction: malignant obstruction of the right mainstem
Tracheal-bronchial papillomatosis
Post-lung transplant anastomotic bronchial stenosis
Chest x-ray showing right mainstem endobronchial stent occlusion with mucus
Airway stenosis secondary to granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
Golden-S or reverse S-sign on chest CT (left image) traced by yellow line. Flexible bronchoscopy (right image) shows the central obstructive lesion at the left mainstem bronchi.
Malignant endobronchial obstruction on multidetector chest CT: lung window demonstrating right mainstem malignant obstruction
Malignant endobronchial obstruction on multidetector chest CT: mediastinal window demonstrating right mainstem malignant obstruction
Malignant endobronchial obstruction on multidetector chest CT: coronal reconstruction demonstrating right mainstem malignant obstruction
Malignant endobronchial obstruction on multidetector chest CT: 3D volume rendering reconstruction demonstrating right mainstem malignant obstruction
Malignant endobronchial obstruction on multidetector chest CT: 2D multiplanar reconstruction (minimal intensity projection) demonstrating right mainstem malignant obstruction
Dynamic airway collapse: A. bronchoscopic view on inhalation; B. bronchoscopic view on exhalation showing dynamic airway collapse; C. CT chest showing normal airway on inhalation; D. CT chest showing significant airway collapse on exhalation
Dynamic (nonfixed or variable) extrathoracic upper airway obstruction: flow-volume loop shows "flattened" inspiratory limb during forced inspiration
Dynamic (nonfixed or variable) intrathoracic upper airway obstruction: flow-volume loop shows "flattened" expiratory limb during forced exhalation
Fixed upper airway obstruction: flow-volume loop shows "flattened" inspiratory and expiratory loops
Post-lung transplant anastomotic bronchial stenosis: right mainstem anastomosis post-multimodal endoscopic therapy
Bronchoscopic therapy for central airway obstruction of the right mainstem: laser photoresection
Post-lung transplant anastomotic bronchial stenosis: electrocautery radial incision
Bronchoscopic therapy for central airway obstruction of the right mainstem: argon plasma coagulation
Post-lung transplant anastomotic bronchial stenosis: balloon bronchoplasty
Bronchoscopic therapy for central airway obstruction of the right mainstem: stent placement
Bronchoscopic therapy for central airway obstruction of the right mainstem: post-mechanical debulking
Citations
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