(below the suprasternal notch) or extrathoracic
Fixed tracheal obstruction may be caused by acquired or congenital tracheal stenosis, primary or secondary tracheal neoplasms, extrinsic compression (tumors of the lung, thymus, or thyroid; lymphadenopathy; congenital vascular rings; aneurysms; etc), foreign body aspiration, tracheal granulomas and papillomas, and tracheal trauma
Tracheomalacia, foreign body aspiration, and retained secretions may cause variable tracheal obstruction
Acquired tracheal stenosis is usually secondary to previous tracheotomy or endotracheal intubation
Dyspnea, cough, and inability to clear pulmonary secretions occur weeks to months after tracheal decannulation or extubation
Physical findings may be absent until tracheal diam- eter is reduced 50% or more, when wheezing, a palpable tracheal thrill, and harsh breath sounds may be detected
The diagnosis is usually confirmed by plain films or CT of the trachea
Complications include recurring pulmonary infection and life-threatening respiratory failure
Management is directed toward ensuring adequate ventilation and oxygenation and avoiding manipulative procedures that may increase edema of the tracheal mucosa
Surgical reconstruction, endotracheal stent placement, or laser photoresection may be required
Bronchial obstruction may be caused by retained pulmonary secretions, aspiration, foreign bodies, bronchomalacia, bronchogenic carcinoma, compression by extrinsic masses, and tumors metastatic to the airway
Clinical and radiographic findings vary depending on the location of the obstruction and the degree of airway narrowing
Symptoms include dyspnea, cough, wheezing, and, if infection is present, fever and chills
A history of recurrent pneumonia in the same lobe or segment or slow resolution (more than 3 months) of pneumonia on successive radiographs suggests the possibility of bronchial obstruction and the need for bronchoscopy
Radiographic findings include atelectasis (local parenchymal collapse), postobstructive infiltrates, and air trapping caused by unidirectional expiratory obstruction
CT scanning may demonstrate the nature and exact location of obstruction of the central bronchi
MRI may be superior to CT for delineating the extent of underlying disease in the hilum, but it is usually reserved for cases in which CT findings are equivocal
Bronchoscopy is the definitive diagnostic study, particularly if tumor or foreign body aspiration is suspected
The finding of bronchial breath sounds on physical examination or an air bronchogram on chest radiograph in an area of atelectasis rules out complete airway obstruction
Bronchoscopy is unlikely to be of therapeutic benefit in this situation
Murgu SD et al
Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction