Laser therapy for an obstructing primary tracheal lymphoma in a patient with AIDS: DISCUSSION (1)
Primary non-Hodgkin’s lymphoma (NHL) is an uncommon malignancy of the trachea. There have been 14 cases reported in the English language literature. Most reports of NHL involving the airway are secondary to mediastinal nodal disease and three of these cases were associated with HIV/AIDS. Patients with HIV/AIDS develop NHL 20 times more frequently than normal populations, and it frequently presents in extranodal locations and is usually advanced. Despite its overall rarity, 27% (four of 15 reported cases [including the present case]) of primary tracheal NHL were found in patients with HIV/AIDS. The present report is the first case where the tumour led to airway compromise and respiratory failure, requiring endoluminal ablation with an Nd:YAG laser as a bridge to definitive chemotherapy. buy antibiotics online
Airway management for tracheal obstruction and respiratory failure is a challenging problem. Bronchodilators and humidified O2 are readily available and can ease respiratory distress, and racemic adrenaline can reduce mucosal swelling. Heliox (30% helium and O2; VitalAire, Canada) reduces airflow turbulence, allowing easier entrainment of O2. These simple measures can convert an emergent case into one that is urgent or elective, avoiding the need for direct airway intervention. In the present case, despite evidence from the flow volume loops and chest radiographs, a tracheal tumour was initially missed. Bronchodilators and humidified O2 were insufficient. Heliox was not used, but might have helped avoid urgent intubation.