DELAYED PRESENTATION OF TRACHEAL CHONDRONECROSIS AFTER CHEST RADIATION THERAPY

Objectives:

Introduction:
Tracheal necrosis is a rare life-threatening condition most commonly occurring after prolonged intubation resulting from pressure-induced ischemia. A less common cause of tracheal necrosis has also been recognized following radiation treatment. Necrosis of the distal tracheal is the rarest documented complication occurring after radiation treatment. This case illustrates a late presentation of chondronecrosis involving the carina.

Case Report:
We report a case of delayed distal trachea chondronecrosis that developed over 15 years after definitive chemoradiation treatment for right-sided lung cancer.

Case Presentation:
68-year-old man with past medical history of metastatic right lung cancer to the adrenal gland status post definitive chemoradiation over 15 years prior and has been without evidence of recurrence, presented to the emergency department with hemoptysis. A paratracheal soft tissue mass was identified on CT. Flexible bronchoscopy with biopsy, YAG laser ablation, and 20mm x 80mm Merit Medical airway stent placement was performed. Pathology yielded acute and chronic inflammation with necrosis. Patient was safely discharged home on post-procedure day three.

Discussion:
Tracheal necrosis is a rare life-threatening complication of therapeutic radiation exposure. In this case, we present a patient presenting after 15 years. Patients may present with productive cough and hemoptysis as our patient did. Diagnosis of tracheal necrosis involves bronchoscopy with biopsy. Effective treatments can range from conservative management with stenting to tracheal resection and anastomosis.

Conclusion/Learning Points:
• Common causes of tracheal necrosis include prolonged intubation, overinflation of tracheostomy cuff, radiation for head and neck cancers, and thyroid surgery.
• The clinical presentation of tracheal necrosis usually occurs months to years after radiation exposure.
• Treatment of tracheal necrosis may include antibiotics, hyperbaric oxygen therapy, laser, balloon bronchial dilatation with or without stent placement, or surgery.
• Surgical treatment is usually of limited benefit due to diagnosis often made at advanced stages.

Methods:

Results:

Conclusion: