Benign Growths Primary In The Tracheobronchial Tree

Sources: 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.