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figure 7-19 (continued) D, Lateral tomogram demonstrates the posterior location of the base of tumor. E, Barium esophagogram shows smooth indentation of the esophagus by the mass. F, Computed tomography scan clarifies the component of tumor extending beyond the tracheal lumen. Carinal resection was required for an adequate margin, and was followed by radiotherapy. She remained well and without recurrence 19 years later.

Functional studies are rarely of much practical use. Obstruction of the central airway requires relief. No matter how diminished the pulmonary reserve is, the patient will be improved by relief of the proximal airway obstruction. The surgical approach to distal tracheal lesions may be altered in the light of very poor pulmonary parenchymal function, however.

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