Revisiting bronchoscopic intratumoral chemotherapy in malignant central airway obstruction via EUS-B approach and its review of literature

https://doi.org/10.4081/monaldi.2020.1324

Authors

  • Ram Niwas | rniwasaiims@gmail.com Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India.
  • Gopal Chawla Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India. https://orcid.org/0000-0002-8735-9774
  • Puneet Pareek Department of Radiotherapy, All India Institute of Medical Sciences, Jodhpur, India.
  • Nishant Kumar Chauhan Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India. https://orcid.org/0000-0003-3491-0275
  • Naveen Dutt Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India.

Abstract

Critical central airway obstruction has always been a dreaded complication to which interventional pulmonologist commonly encounters. There have been various modalities which are used for the management and palliation, which includes mechanical coring, laser, cryoextraction, electrocautery and airway stenting. Rigid bronchoscopy with or without jet ventilation has been corner stone of therapeutics and palliation of central airway obstruction. There are only a few conditions where it is not possible to use rigid bronchoscopy. Here we report a case of metastatic tracheal tumour which presented with critical airway obstruction in a patient who had atlantoaxial instability (AAI) due to rheumatoid arthritis. Here we used endobronchial ultrasound scope (EBUS) via esophageal route, i.e. EUS-B guided approach for sampling of the tracheal tumour, and intratumoral chemotherapy was instilled in multiple sessions, which resulted in shrinking of tumour, thus relieving the critical airway obstruction. This is the first report of using EUS-B approach for intratumoral chemotherapy for tracheal tumors. Bronchoscopic intratumoral chemotherapy therapy (BITC) in tracheal tumors is also one of the options but has not been explored much and there has been a dearth of literature for it.

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Published
2020-10-15
Info
Issue
Section
Pneumology - Case Reports
Keywords:
Tracheal tumour, intralesional chemotherapy, atlantoaxial subluxation, EUS-B
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How to Cite
Niwas, Ram, Gopal Chawla, Puneet Pareek, Nishant Kumar Chauhan, and Naveen Dutt. 2020. “Revisiting Bronchoscopic Intratumoral Chemotherapy in Malignant Central Airway Obstruction via EUS-B Approach and Its Review of Literature”. Monaldi Archives for Chest Disease 90 (4). https://doi.org/10.4081/monaldi.2020.1324.

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