Tracheobronchomalacia treated by inserting a long T-tube into the left main bronchus.
An 88-year-old woman with advanced Parkinson's disease (stage V on the Yahr scale) had difficulty in expectoration and underwent tracheostomy in 1999. In July 2004, granulation tissue was formed in the tracheal lumen at the tip of the tracheostomy tube, and a standard type silicone T-tube was inserted. Thereafter, she was cared for at home, where she was doing well until early March 2009, when a decrease in SaO(2) and difficulty in sputum aspiration were noted. Bronchoscopy showed crescent type tracheobronchomalacia involving the trachea down to the orifice of the left main bronchus. Considering its localization, an intact right main bronchus, a history of tracheostomy tube placement resulting in granulation tissue formation in the lower trachea, and the future need for frequent sputum aspiration, we inserted a long T-tube into the left main bronchus, which is easily replaceable and facilitates sputum aspiration. Right-lung ventilation was maintained through a side aperture made in the long T-tube. After its insertion, her respiratory status stabilized, secretion drainage improved, and she was discharged for treatment at home. Herein, we describe a tracheobronchomalacia patient in whom airway patency was achieved by inserting a long T-tube with a side aperture into the left main bronchus.
Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan. tgoto@ntmc.hosp.go.jp
Taichiro
T
Goto
Yoshitaka
Y
Oyamada
Misa
M
Wakaki
Ryoichi
R
Kato
D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D001999:Bronchoscopy; D015505:Chest Tubes; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D010300:Parkinson Disease / Q000628:therapy*; D012121:Respiration, Artificial / Q000295:instrumentation; D012720:Severity of Illness Index; D013396:Suction / Q000295:instrumentation; D055089:Tracheobronchomalacia / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome