The Journal of the Japan Society for Respiratory Endoscopy
Online ISSN : 2186-0149
Print ISSN : 0287-2137
ISSN-L : 0287-2137
A Case in Which Snare Ablation Was Safely Performed After Systemic Steroid Administration Reduced the Size of a Post-tracheostomy Pedunculated Granular Lesion
Fumi KarinoShinichi IwamotoAkihisa SutaniTakashige KurakiTakeshi Isobe
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2012 Volume 34 Issue 6 Pages 599-603

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Abstract

Background. Airway constriction caused by granulomatous lesions after tracheotomy is one of the serious causes of central airway stenosis. We report a case of a granuloma in which size reduction was successfully achieved by systemic administration of steroids, and we were thereafter able to safely perform snare ablation. Case. The case involved a man in his 60's. Tracheotomy had been performed during surgery for tongue cancer, and the trachea tube had been removed on postoperative day 13. He began to experience airway obstruction during exhalation around three months after surgery. Due to the fact that dyspnea symptoms began to gradually worsen in the supine and left lateral decubitus position, he was hospitalized for further examination. The contrast CT findings showed tracheal stenosis due to pedunculated granulation measuring 9×15mm in size. Bronchoscopy demonstrated a movable mass in the trachea which had markedly narrowed the tracheal lumen. Because he could not remain in a supine position for long periods of time, and the risk of suffocation was high, immediate intervention was thus considered to be impossible. After the systemic administration of steroids was performed, the granulomatous lesions were observed to have significantly decreased in size and he felt an improved sense of airway flow. Ablation was thereafter performed under general anesthesia and we were able to maintain the airway perfectly using a rigid scope snare. Conclusion. We herein report the findings of a case presenting with pedunculated granuloma after tracheostomy which a reduction in the size of the granuloma was successfully achieved using a sufficient amount of systemic steroids before snare ablation could be safely performed.

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© 2012 The Japan Society for Respiratory Endoscopy
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