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Benign Growths Primary In The Tracheobronchial Tree
Category: BENIGN NEOPLASMS OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Extension of papillomata from the larynx into the cervical trachea,
especially about the tracheotomy wound, is of relatively common
occurrence. True primary growths of the tracheobronchial tree, though
not frequent, are by no means rare. These primary growths include
primary papillomata and fibromata as the most frequent, aberrant
thyroid, lipomata, adenomata, granulomata and amyloid tumors.
Chondromata and osteochondromata may be benign but are prone to
develop malignancy, and by sarcomatous or other changes, even
metaplasia. Edematous polypi and other more or less tumor-like
inflammatory sequelae are occasionally encountered.
Symptoms of Benign Tumors of the Tracheobronchial Tree.--Cough,
wheezing respiration, and dyspnea, varying in degree with the size of
the tumor, indicate obstruction of the airway. Associated with
defective aeration will be the signs of deficient drainage of
secretions. Roentgenray examination may show the shadow of
enchondromata or osteomata, and will also show variations in aeration
should the tumor be in a bronchus.
Bronchoscopic removal of benign growths is readily accomplished with
the endoscopic punch forceps shown in Figs. 28 and 33. Quick action
may be necessary should a large tumor producing great dyspnea be
encountered, for the dyspnea is apt to be increased by the congestion,
cough, and increased respiration and spasm incidental to the presence
of the bronchoscope in the trachea. General anesthesia, as in all
cases showing dyspnea, is contraindicated. The risks of hemorrhage
following removal are very slight, provided fungations on an
aneurismal erosion be not mistaken for a tumor.
Multiple papillomata when very numerous are best removed by the
author's coring method. This consists in the insertion of an
aspirating bronchoscope with the mechanical aspirator working at full
negative pressure. The papillomata are removed like coring an apple;
though the rounded edge of the bronchoscope does not even scratch the
tracheal mucosa. Many of the papillomata are taken off by the holes in
the bronchoscope. Aspiration of the detached papillomata into the
lungs is prevented by the corking of the tube-mouth with the mass of
papillomata held by the negative pressure at the canal inlet orifice.
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