“Cooking the beast” microwaves: A new fast method for reopening the airways

Microwave ablation (MWA) has been used to treat lung, kidney and liver cancer and metastases ( Wolf FJ et al. Radiology 2008;247:87 ). To our knowledge there is no report of transbronchial use of MWA for the treatment of mediastinal lesions harming airway patency. A 74 year old woman was admitted to our hospital for dyspnea and worsening dysphagia. CT scan showed an enlarged subcarinal mass compressing both main bronchi. Bronchoscopy confirmed massive enlargement of the main carina with cancellation of the left main bronchus and 15% residual lumen of the right one, TBNA revealed squamous cell lung cancer. The intact mucosa prevented the use of laser to restore lumen patency. MWA was then applied through a dedicated needle catheter in 6 separate bursts (25 to 140 sec, 40 to 50 watts) inserting the catheter through the medial wall of the right and left main bronchi with immediate reduction of the compressing mass. Two silicone stents (13 mm diam) were then inserted to maintained airway patency of both main bronchi. The procedure was uneventful, dyspnea and dysphagia resolved.