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Miscellaneous



Granulomas are always caused by inflammation of the airway. In our experience, sutures are often to blame.
Granulomas caused by sutures will almost always recur unless the suture is removed in its entirety.



The example shown here is that of a 2 year old patient status post surgical repair of an aortic malformation.

The infant’s trachea is obstructed by a large anterior granuloma which affects 80% of the airway lumen.

The series of images illustrates the cause and treatment of this granuloma.

This film shows endoscopic resection of numerous sutures following pneumonectomy.

The biopsy forceps is generally inadequate, but the sutures can be sectioned with the endoscopic scissors or the laser.

The metal suture shown, was cut by two YAP laser discharges using high power (40 watts).



Broncholiths can be obstructive or lead to hemoptysis.

They should be approached with great caution given the significant risk of bleeding.

Extrinsic airway compression may be lymphatic or vascular in origin.

An example of extrinsic compression of the airway by tuberculous adenopathy is seen to the right, while an aortic aneurysm obstructs the entire tracheo-bronchial tree on the left.



Bronchial fistulas post-pneumonectomy are very difficult to treat. The goal is to reduce the fistula by tissue retraction.

Adequate drainage of the cavity coupled with careful local endoscopic treatment are essential.

All sutures must be resected, followed by irritation of the entire bronchial wall by whatever means available in order to cause inflammation and tissue retraction.

We have obtained good results combining nitrate and laser therapy in these patients, although multiple sessions are often necessary.

 
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