Efficacy of nasal continuous positive airway pressure in tracheobronchomalacia

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type:TOHO University Scholarly Publication

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A 68-year-old woman was admitted to our hospital with a persistent productive cough of 1 year's duration and dyspnea on exertion. She had a history of chronic bronchitis during childhood and no history of smoking. Chest computed tomography (CT) images on expiration revealed diffuse mosaic attenuation in both lungs and airway collapse of the trachea and main bronchi. Fiberoptic bronchoscopy images showed a triangular tracheal lumen and marked narrowing of the main bronchi on expiration. Virtual bronchoscopy (VB) images showed subtotal stenosis of several segmental bronchi. In addition, three-dimensional (3D) images of the airways revealed excessive expiratory collapse of the trachea and distal discrete malacia. No abnormalities were seen in a surgical lung biopsy specimen. These findings indicated a diagnosis of tracheobronchomalacia (TBM). Because the airway lesions were diffuse, noninvasive ventilation with continuous positive airway pressure was started and resulted in long-term improvement in daytime clinical symptoms and arterial blood gas values.68歳女性.1年間持続する咳嗽,労作時呼吸困難を主訴に来院.喫煙歴なし.幼少時より慢性気管支炎を指摘.胸部computed tomography(CT)ではモザイクパターンを呈し,呼気時に増強する気管の高度狭窄を認めた.Virtual bronchoscopyでは,気管支末梢まで狭窄を示した.気道three-dimensional(3D)再構築像では,呼気時に気管・気管支の著明な狭窄を認めた.胸腔鏡下肺生検では明らかな異常所見は認められなかった.以上より気管・気管支軟化症と診断した.気道病変がびまん性であったため,非侵襲的陽圧換気療法を開始したところ,臨床症状および動脈血液ガスの改善を認めた.

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