Diagnostic Studies

Only very rarely will the imaging studies described in Chapter 4, "Imaging the Larynx and Trachea," fail to define the location and extent of a tracheal tumor (Figure 7-19). Oblique tomography or thin-section CT scan will usually identify small and otherwise subtle tracheal lesions. Virtual bronchoscopy may add a pictorial dimension, although it is not essential. If pulmonary lesions are also discovered, a fine needle percutaneous biopsy is useful to determine their nature.

Bronchoscopy is essential sooner or later (see Chapter 5, "Diagnostic Endoscopy"). The number of tracheal lesions overlooked or diagnosed late will be minimized if bronchoscopy is routinely used in the following circumstances: 1) patients who suffer from prolonged cough, dyspnea on exertion, and wheezing or stridor—without precise and proven diagnosis; 2) patients with hemoptysis; 3) patients with recurrent atelectasis, pneumonitis, pneumonia, or persistent unexplained pulmonary infiltrate. Where a lesion has been identified radiologically, is not unusually extensive, and clearly would be best treated by resection, a rigid bronchoscopy is often deferred to the general anesthesia under which resection is planned. The endo-scopic management of severe acute obstruction by tumor is outlined in Chapter 19, "Urgent Treatment of Tracheal Obstruction." If there is possible hazard from an attempt at biopsy and the patient is to be referred to a center for definitive surgical resection, biopsy is best deferred.

Table 7-5 Duration of Symptoms and Resectability

Tumor Type

ACC (months)

SCC (months)

Resectable

18.3(14.6-21.9)

4.5(3.6-5.5)

Unresectable

23.7(15.1-32.3)

7.6(2.8-12.4)

Adapted from Gaissert HA et al.6 The range is given in parenthesis.

ACC = adenoid cystic carcinoma; SCC = squamous cell carcinoma.

Adapted from Gaissert HA et al.6 The range is given in parenthesis.

ACC = adenoid cystic carcinoma; SCC = squamous cell carcinoma.

figure 7-19 Radiologic definition of adenoid cystic carcinoma in a 28-year-old woman. A, Standard posteroanterior view shows little obviously abnormal. The arrow indicates tumor in the lower trachea. B, Large lower tracheal mass is seen near the carina on a lateral roentgenogram. C, Anteroposterior tomogram outlines the supracarinal mass.

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