Tuberculous bronchial stenosis: treatment with balloon bronchoplasty

A 58-year-old man with fever and dyspnea had pulmonary tuberculosis, for which he was being treated with antituberculous medications. Because of persistent dyspnea on exertion, he was referred to our hospital, where bronchoplasty was done to treat a stenosis in the left main bronchus. During the follow-up period of 16 months after the operation, the dyspnea on exertion was noted to increase and a concentric stenosis at the site of the bonchoplasty was revealed by a bronchoscopic examination. One month after that, balloon dilatation was done as follows: A flexible bronchoscope (Olympus, Tokyo) was inserted in the trachea through a mouthpiece. To determine the appropriate balloon size, we injected a contrast medium (15 ml of propyliodone) through the bronchoscope to outline the stenotic site and the bronchus beyond it. A 0.035-in. (0.09 cm) J guidewire (Terumo, Tokyo) was placed transbronchoscopically through the stenotic bronchus, and then the bronchoscope was withdrawn, leaving only the guidewire. A 7-French, 10-mm angioplastic balloon catheter (Medi-tech, Watertown, MA) was introduced over the wire and placed in the midportion of the stenosis. After that, under fluoroscopic observation, the balloon was inflated with a diluted contrast solution (amidotrizoic acid) from 10 sec to 2 mm with a maximal pressure of 6 atm (6.1 x 10 Pa). The balloon inflations were repeated after the balloon’s position was adjusted until the stenosis disappeared. The dilatation of the stenotic bronchus was confirmed by injection of contrast medium through the catheter. Finally, bronchoscopic examination was repeated to check for local trauma or bleeding, and the bronchoscope was removed after aspirating the contrast medium in the bronchi. For 3 days, the patient had a fever, which responded to broadspectrum antibiotics. No other complications occurred. One week later, bronchoscopic and bronchographic examinations showed an increase from 4.6 to 6.0 mm in the diameter of the left main bronchus (Fig. 1). One month after balloon dilatation, pulmonary function tests showed improved lung volumes and large-airway obstruction. slmKr ventilation scintigraphy performed after the bronchial dilatation showed improved ventilation in the left lung, which had been hypoventilated on the scintigram obtained before dilatation. After balloon dilatation, the patient was followed up for 8 months, and during that period he had no recurrence of dyspnea on exertion.