Surgical treatment of a rare case of tracheal inflammatory pseudotumor in pediatric age.
Tracheal inflammatory pseudotumor (IPT) is a rare solid lesion with an unpredictable biological course. Treatment can vary and surgical resection may sometimes be necessary, even in pediatric age. We report the case of a 12-year-old male patient who presented to our institution with sudden dyspnoea after some months of wheezing and cough, wrongly considered and treated as asthma. Neck-chest CT-scan and fiberbronchoscopy showed an intraluminal tracheal mass, originating from the left antero-lateral wall at the level of the 5th cartilagineous tracheal ring, involving three rings, that was removed by rigid bronchoscopy. Histopathology revealed a tracheal IPT. Due to rapid tendency to recurrence of the lesion, two more endoscopic recanalizations were performed, but a new recurrence appeared, with CT evidence of transmural involvement of the tracheal wall. Resection of the three involved tracheal rings and termino-terminal tracheal anastomosis were successfully performed through cervicotomy and sternal split. CT-scan and fiberbronchoscopy at 17 months from surgery show a stable tracheal lumen without signs of recurrence. A tracheal IPT should be suspected in any pediatric patients with tracheal mass and asthmatic symptoms. After radical removal prognosis is generally excellent and recurrences after tracheal resection are rare.
De Palma
Angela
A
Sezione di Chirurgia Toracica, Università degli Studi di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy. adepalma@chirtor.uniba.it
Loizzi
Domenico
D
Sollitto
Francesco
F
Loizzi
Michele
M
D001249:Asthma / Q000175:diagnosis; D001706:Biopsy; D001999:Bronchoscopy; D002648:Child; D003951:Diagnostic Errors; D006104:Granuloma, Plasma Cell / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D012008:Recurrence; D019616:Thoracic Surgical Procedures; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome