CRA32 COMPLEXITIES OF POST-TUBERCULOSIS TRACHEOBRONCHIAL STENOSIS (PTTS): BALLOON DILATATION AND BEYOND

Authors names:
Komathi Palani1, Yen Shen Wong2, Chen Yong Tan1, Sumithra Appava1, Haly Rozie Ahmad1, Mona Zaria Nasaruddin1, Jamalul Azizi Abdul Rahaman1
Authors Affiliations:
1Pulmonology Department, Sultan Idris Shah Serdang Hospital, Selangor, Malaysia
2Faculty Of Medicine, Universiti Teknologi Mara (UiTM) Sg Buloh, Selangor, Malaysia

Background 

Post-tuberculosis tracheobronchial stenosis (PTTS) is a prevalent cause of benign central airway obstruction in Malaysia. Despite being classified as a benign condition, PTTS may prove to be technically challenging. We report a complex PTTS case that ultimately resulted in the patient's death, despite multiple airway interventions. 

Case report: 

A 36-year-old woman with a history of pulmonary tuberculosis in 2014 presented after eight years with progressive dyspnea. Initially misdiagnosed as asthma, a CT thorax revealed long-segment stenosis of the trachea (43 mm) and left main bronchus (21 mm). Flexible bronchoscopy confirmed a long segment tracheal fibrostenosis with pinpoint stenosis at the left main bronchus (LMB). 

Due to the complexity of the stenosis, a multidisciplinary team found her unsuitable for surgical resection. She underwent multiple rigid bronchoscopies with balloon dilatation and mitomycin application, but recurrence occurred within a month. A silicone tracheal stent was placed but led to severe granulation tissue formation, blocking 90% of the distal stent. Forceps and Argon plasma coagulation (APC) were used to remove the granulation tissue, and a biodegradable stent was inserted. The stent degraded after three months, leading to restenosis. 

The patient later required a metallic stent for central airway obstruction, which was complicated by stent migration, mucus impaction, lung collapse, and obstructive pneumonia. Despite extensive treatments, she ultimately succumbed to the complications of PTTS. 

Conclusion:

PTTS remains a formidable challenge in clinical management, especially in cases involving long-segment and multilevel stenosis. Balloon dilatation, while useful, often requires adjunct therapies to manage recurrence. Stenting, whether silicone or biodegradable, may provide temporary relief but is not without significant complications. This case underscores the need for developing more effective and durable treatment strategies such as custom-made airway stents to improve outcome for patients with this complex condition.