Lung Tumor Airway Obstruction

Patient History

The patient presented with increasing breathlessness, and was noted to have a stridor on physical exam. She was severely distressed, and had great difficulty with lying flat. An upper airway obstruction was considered likely. A careful examination of the upper airway (see movie), with a flexible bronchoscope showed critical narrowing of the distal third of the trachea. The extent of this narrowing could not be determined, as the bronchoscope could not be passed distal to the tumor, and the risk of hemorrhage, and edema, made any attempt to examine the airway further hazardous. The patient had previously had chest radiation therapy for breast cancer some 12 years before.

Contributions of Volumetric Imaging to Case Outcome

A regular CT SCAN had been performed, this demonstrated the narrowed trachea, but did not clearly show the distal extent of the tumor. Laser surgery was planned; a Volumetric analysis ofa newly obtained CT SCAN (see protocol) clearly showed that the origin of the left main bronchus was also severely narrowed, this was later confirmed upon bronchoscopy. In addition the VIDA reconstructed views showed the extent of the tumor within the trachea, and the relationship to other vital structures. The tumor extended posteriorly beyond the airway, pressing against the aorta. Laser surgery was performed to clear away part of the tumor from the trachea and left main bronchus, with a clear understanding prior to the procedure that the right main bronchus could be intubated if the patient experienced difficulties during the procedure. In addition we had confidence that the obstructing segment in the trachea was of a manageable length, thereby justifying the potential risks of laser resection.

MPEG Movies

CT scan before treatment March 1996

CT scan After Laser Surgery

Surface Display of Airway March 1996

Surface Display of Airway, Tumor, and Aorta March 1996

Surface Display of Airway April 1996

Bronchoscopic image before surgery.

Bronchoscopic image

Done in March 1996.

Bronchoscopic image

Done in March 1996.

Virtual Bronchoscopic image

Bronchoscopic image

Done in May 1996.

Bronchoscopic image

Done in Nov. 1996.

Measurements

Tube Geometry was used to measure the airway dimensions so that an appropriately sized stent could be placed in the patient's trachea to keep it patent.

From March 1996

Tube Geometry Analysis Summary
Date            : Wed Apr 22 15:17:11 1998
scan date       : 03-13-96
Oblique slices  : 31
Segmented image : tg_int
Original image  : tg_int
 
Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1     124.657  11.895   12.715  (241.10,276.83,  4.13)  15.374   9.723      11.021 
    2     164.527  15.176   13.125  (241.61,282.36,  6.49)  16.610  11.838      12.741 
    3     167.891  15.586   13.125  (241.14,282.55, 10.41)  16.391  12.332      13.086 
    4     172.602  15.176   13.945  (240.19,283.17, 14.20)  15.832  12.741      14.029 
    5     177.985  15.176   13.945  (240.34,283.97, 18.02)  16.163  13.125      14.355 
    6     171.929  15.586   12.715  (239.89,284.55, 21.86)  16.117  12.312      12.635 
    7     160.321  15.176   12.715  (239.09,286.02, 25.42)  15.314  11.958      12.721 
    8     156.284  15.586   12.715  (239.09,286.75, 29.29)  15.608  11.484      11.923 
    9     150.732  15.586   11.484  (238.10,287.67, 33.01)  15.591  11.195      11.492 
   10     144.508  15.176   10.664  (238.00,288.19, 36.93)  15.445  10.672      10.859 
   11     150.059  15.996   11.074  (237.03,288.89, 40.70)  16.184  10.735      10.859 
   12     136.096  15.586   11.484  (236.51,288.66, 44.62)  16.017   9.861      11.344 
   13     131.386  15.996   11.074  (234.46,288.66, 48.02)  16.043   9.353       9.469 
   14     126.339  15.176   11.074  (233.17,288.01, 51.73)  15.198   9.654      10.672 
   15     108.843  14.355   10.664  (232.23,286.53, 55.50)  14.501  10.089      10.384 
   16     105.311  14.766   10.664  (231.42,287.71, 59.40)  14.817   9.299      10.696 
   17      79.908   9.434   10.664  (231.74,282.02, 61.45)  11.315   7.706       9.575 
   18      58.880   6.973    9.844  (229.40,282.93, 66.96)   9.988   6.097       6.097 
   19      45.590   6.562    9.434  (227.19,284.09, 71.03)   9.217   5.253       5.713 
   20      35.328   4.512    9.844  (226.84,283.50, 75.75)   9.254   3.504       3.781 
   21      31.122   4.102    9.844  (225.95,284.15, 80.17)   9.469   2.871       3.124 
   22      29.103   4.102   10.254  (225.36,283.93, 84.68)   9.469   2.461       2.594 
   25      32.132   5.332   12.305  (226.69,285.44, 98.05)  11.673   2.392       2.751 
   26      37.851   5.332   14.766  (227.99,288.22,102.37)  14.029   2.209       2.209 
   28      36.001   6.973    7.383  (223.13,291.38,110.28)   8.121   4.922       5.220 
   30      74.020  13.125    8.613  (220.45,297.86,121.50)  12.635   7.890       8.456

From April 1996

Trachea Measurements

Tube Geometry Analysis Summary
Date            : Mon Apr  8 21:31:34 1996
Oblique slices  : 31
Segmented image : trach.tga.seg
Original image  : trach.tga.ori
 
Slice Area [mm^2] AP [mm] Lat [mm]               Position    Major   Minor  Orthogonal
    1     261.934  20.352   16.112  ( 69.30, 37.85, 10.35)  20.944  14.503      15.434 
    2     238.023  18.232   15.264  ( 70.01, 42.25, 17.06)  18.409  14.864      14.991 
    3     240.540  19.080   15.688  ( 70.61, 45.04, 23.04)  19.211  15.270      15.590 
    4     233.169  19.080   14.840  ( 71.38, 46.90, 29.35)  19.337  14.422      14.503 
    5     226.698  17.808   14.840  ( 70.76, 49.63, 35.25)  19.211  14.247      14.253 
    6     220.585  18.232   14.840  ( 71.61, 51.42, 41.47)  19.155  13.863      14.221 
    7     218.967  17.808   14.416  ( 71.58, 53.03, 47.74)  18.833  13.947      14.620 
    8     213.754  17.808   13.992  ( 70.89, 55.17, 53.82)  18.394  13.575      14.416 
    9     202.068  17.384   13.992  ( 70.28, 56.76, 60.07)  17.969  13.575      13.947 
   10     195.956  16.536   13.992  ( 70.84, 58.44, 66.31)  17.813  13.007      14.171 
   11     192.360  16.536   13.992  ( 69.91, 59.99, 72.51)  17.554  12.833      14.503 
   12     184.270  16.112   13.568  ( 69.42, 61.03, 78.87)  16.536  13.171      13.700 
   13     189.843  16.536   13.992  ( 70.22, 62.39, 85.20)  17.265  13.151      13.654 
   14     191.641  16.960   13.568  ( 70.10, 63.05, 91.68)  17.029  12.727      13.811 
   15     183.731  16.960   12.296  ( 69.44, 64.71, 97.93)  17.029  11.727      13.007 
   16     163.596  16.536   12.296  ( 67.94, 66.34,104.05)  16.628  11.024      11.666 
   17     137.708  15.264   11.448  ( 66.75, 63.84,110.22)  15.434   9.789      11.940 
   18     114.697  13.144   10.600  ( 65.38, 63.82,116.85)  13.253   9.669      10.735 
   19     104.630  12.296   10.176  ( 64.65, 64.82,123.41)  12.362   9.761      10.211 
   20      99.776  11.024   10.600  ( 62.65, 65.64,129.73)  11.417   9.926      11.024 
   21      93.843  11.024   10.176  ( 62.37, 66.73,136.25)  11.290   9.669      10.351 
   22      87.551  11.024    9.752  ( 60.45, 67.82,142.48)  11.417   9.613       9.789 
   23      84.495  11.024    8.904  ( 59.20, 68.27,149.00)  11.573   8.585       8.731 
   24      83.057  11.024    8.904  ( 57.26, 70.60,154.91)  11.266   8.522       8.585 
   25      86.292  11.872    8.904  ( 56.83, 72.06,161.29)  11.902   8.533       8.944 
   26      92.405  11.448    9.328  ( 56.68, 73.07,167.76)  11.940   8.994       9.789 
   27      93.843  11.024    9.752  ( 56.35, 74.84,174.12)  11.758   9.528       9.862 
   28     103.191  11.024   10.600  ( 57.90, 76.68,180.29)  13.062   9.935      10.114 
   29      99.236  11.024   11.448  ( 58.20, 80.06,185.98)  13.314   9.014       9.074 
   30      94.922   9.752   11.872  ( 59.26, 82.39,192.09)  13.314   8.731       8.741 
   31     108.944  11.448   13.144  ( 60.72, 84.69,198.37)  14.937   8.101       8.233