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Interventional Therapies for Central Airways

Dunlap, Daniel G. MD*; Ravenel, James MD, FACR; Sechrist, Jacob MD; Semaan, Roy MD*

doi: 10.1097/RTI.0000000000000415
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Central airway obstruction (CAO) is a dangerous and increasingly common problem. CAO refers to lesions causing narrowing of the trachea or mainstem bronchi and is generally divided into malignant and nonmalignant categories. These 2 entities may be caused by a variety of thoracic and extrathoracic diseases. Imaging is critical during the initial assessment of CAO and may help thoracic physicians focus the differential diagnosis and plan the safest and most appropriate diagnostic and therapeutic interventions. However, direct visualization via flexible or rigid bronchoscopy is often necessary for diagnostic and treatment purposes. A large number of procedures can be performed through bronchoscopy, with the goal of relieving the obstruction and improving patency of the airway. Deciding which procedure to perform is based both upon the type of lesion and whether the lesion is due to a malignant or nonmalignant process. Possible interventions include mechanical debridement, laser therapy, argon plasma coagulation, electrocautery, brachytherapy, and stent placement. Immediate postoperative and follow-up imaging is crucial to monitor for immediate, subacute, and chronic complications as well as disease progression and recurrence.

*Section of Interventional Pulmonology, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center

Cardiothoracic Radiology, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA

Department of Radiology and Radiologic Science, Medical University of South Carolina, Charleston, SC

The authors declare no conflicts of interest.

Correspondence to: Roy Semaan, MD, Section of Interventional Pulmonology, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, NW 628 UPMC Montefiore, 3459 Fifth Avenue, Pittsburgh, PA 15213 (e-mail: semaanrw2@upmc.edu).

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