J Korean Soc Radiol.  2014 May;70(5):343-346. 10.3348/jksr.2014.70.5.343.

Extrinsic Tracheal Compression Caused by Scoliosis of the Thoracic Spine and Chest Wall Deformity: A Case Report

• Beck KS
• Lee BY
• Kim HS
• Song KS
• Kang HH
• Lee SH
• Moon HS

• KMID: 1941778
• DOI: http://doi.org/10.3348/jksr.2014.70.5.343

Abstract

Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

MeSH Terms

Airway Obstruction
Arteries
Bronchoscopy
Congenital Abnormalities*
Fistula
Hemorrhage
Humans
Male
Scoliosis*
Spine*
Stents
Thoracic Wall*
Tomography, Spiral Computed
Trachea
Tracheostomy

Figure

• 

  Fig. 1 18-year-old male with intractable respiratory distress. A. Initial chest radiograph at our hospital shows severe scoliosis and nonvisualization of a segment of distal trachea (arrowheads) caudal to the intubation tube. The carina can still be seen. B. Axial contrast-enhanced CT image at the level of T3 vertebra and upper end of sternal manubrium shows markedly narrowed mediastinal space and resultant extrinsic compression of the trachea (arrowhead) especially by the brachiocephalic artery (arrow) that courses between the manubrium and the vertebral body. C. Sagittal reconstructed CT image clearly demonstrates the straightened thoracic spine and extremely narrow space between the sternal manubrium and T3 vertebra. Note how brachiocephalic artery (arrow) also contributes to the compression of the trachea in between. D. Axial contrast-enhanced CT image at the level of T5 vertebra shows splaying of the lower trachea by the vertebral body. E. Bronchoscopy before the tracheal stent placement shows the extrinsic compression of the distal trachea, especially on the right side (arrowheads). F. Chest radiograph after the placement of the silicone stent shows the stent just above the carina, maintaining patency (arrowheads). G. Bronchoscopy performed four days after the stent insertion shows well-placed silicone stent inside the distal trachea. Note.-L = left

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