Airway & Bronchoscopy

Management of Non-Malignant Central Airway Obstruction

Reviews classification, diagnostic imaging, airway stabilization, dilation/incision techniques, adjuvant therapies, and long-term follow-up pathways for benign CAO.

Benign CAO • Dilation techniques • Adjuvant therapyReading time · 28mWord count · 3,910

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Exam mapping & scope

Exam Mapping & Scope: This chapter covers benign central airway obstruction (CAO) and expiratory central airway collapse (ECAC), including structural stenoses (post-intubation/tracheostomy, post-infectious, inflammatory/immune-mediated, idiopathic, transplant-related), intraluminal benign tumors, extrinsic compression/distortion, and dynamic entities (tracheobronchomalacia [TBM], excessive dynamic airway collapse [EDAC]). It emphasizes diagnosis, stabilization, bronchoscopic and surgical management, stents, peri-procedural anesthesia/ventilation, complications, and outcomes with an exam-focused approach for AABIP/CAQ.

Focus this round

Etiology-specific algorithms
Scar modulation
Surveillance planning

High-yield pearls

Definition: Clinically significant CAO ≈ >50% reduction in cross-sectional area (CSA) of trachea/main bronchi/bronchus intermedius.
Symptoms vs. Caliber: DOE typically when lumen <25–50% of normal; rest symptoms/stridor ≈ ~5 mm tracheal diameter.
Emergency Priorities: Don’t force an ETT through a tight stenosis; park the ETT proximal to the lesion or use an LMA. Avoid upfront tracheotomy if feasible. Early call for rigid bronchoscopy in the OR. Consider VV-ECMO (or standby cannulas) when there is a high risk of losing the airway.
Imaging: High-resolution CT defines length, mechanism, and distal patency; paired end-inspiratory/dynamic expiratory CT evaluates EDAC/TBM.
Spirometry Clues: Flattened inspiratory/expiratory limbs (fixed obstruction); variable extrathoracic vs. intrathoracic patterns; biphasic curve may suggest a main bronchial lesion; “saw-tooth” pattern can appear with TBM/upper airway flutter.
Simple: Concentric, weblike, length <10 mm, no malacia → radial cuts + gentle ballooning (mucosa-sparing).
Complex: ≥10 mm and/or cartilage damage/malacia → likely needs stenting ± surgery.
Mucosa-Sparing Technique: 3 radial incisions into fibrotic bands (avoid normal mucosa), then low-trauma balloon dilation.

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