Recurrent Idiopathic Tracheal Stenosis Treated with Sequential Endoscopic Tracheoplasty for Two Different Modalities: A Case Report

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Idiopathic tracheal stenosis is an extremely rare disease that can constrict the airway, with no established therapeutic strategy. We herein present our experience with a patient with recurrent idiopathic tracheal stenosis treated with sequential endoscopic tracheoplasty using different modalities. A 41-year-old woman presented with dyspnea and wheezing 6 years ago, which gradually worsened over time. Chest computed tomography revealed tracheal stenosis caused by fold-like structures 15 mm below the glottis. Spirometry results indicate central airway stenosis. Bronchoscopy revealed significant tracheal stenosis due to a circumferentially protruding web-like structure. Pathological tissue biopsy revealed nonspecific inflammation and granulation. The patient was diagnosed with idiopathic tracheal stenosis in the absence of any obvious alternative causes. Argon plasma coagulation (APC) therapy was performed because of severe dyspnea and decreased peak flow. Her dyspnea and pulmonary function improved immediately after treatment. Follow-up bronchoscopy after 6 months revealed significant improvement in the stenosis; however, the lesion recurred 10 months after treatment. Therefore, tracheoplasty using a cryoprobe and balloon dilatation was performed as a second treatment, resulting in another successful improvement. Endoscopic tracheoplasty using APC or cryoprobe is effective for idiopathic tracheal stenosis, thereby enabling the selection of treatment strategies at each facility.