Laser therapy for an obstructing primary tracheal lymphoma in a patient with AIDS (2)
Her past medical history was significant for a 23-pack-year history of smoking and numerous respiratory illnesses. Eight months before, she had undergone bronchoscopy and had no abnormalities identified. She had been HIV-positive for eight years and had been noncompliant with antiretroviral medications for 18 months.
Twelve hours after admission, the patient deteriorated with worsening dyspnea and stridor despite continuous bron-chodilator therapy. Arterial blood gas analysis showed a hyper-carbic, hypoxic respiratory acidosis on 100% O2. Following transfer to the intensive care unit, she was intubated and stabilized. Further review of her lateral chest radiograph suggested a narrowing in the distal trachea (Figure 2). Bronchoscopy confirmed a friable, exophytic mass arising from the posterolateral trachea measuring 4.5 cm in length, ending 1.0 cm above the carina and occupying 80% of the lumen. At the level of the tumour, there was evidence of complete obstruction of the airway with respiration. An endotracheal tube was placed beyond the tumour using a flexible bronchoscope as a guide. Biopsy confirmed that the tumour was a large B cell lymphoma. buy prednisone
Figure 2) Lateral chest radiograph showing a narrowing in the distal trachea