Esophageal lymph node metastasis causing airway obstruction

Excerpt

A 69-year-old Japanese woman with no relevant medical history developed dyspnea 1 week prior to hospitalization. On admission, her blood pressure was 200/100 mmHg; pulse, 110 bpm; body temperature, 36.8 °C; respiration, 40 breaths/min; and SpO₂, 80 % (room air). Physical examination showed stridor and seesaw respirations but no swollen lymph nodes or tenderness to palpation from moving the larynx side-to-side, which would suggest epiglottitis. Severe respiratory distress made bronchoscopy difficult. Thus, we immediately performed cervical computed tomography (CT). CT showed near-total tracheal obstruction due to a tumor behind the upper main bronchi (Fig. 1), so we performed emergency tracheotomy under the tumor with local anesthesia (Fig. 2) and performed radiation therapy. Endoscopic tracheal biopsy and esophageal biopsy revealed lymph node metastasis due to esophageal cancer indicating stage IV cancer, which did not preclude esophageal cancer resection. Oncologic airway emergency is rarely caused by lymph node metastasis. Patients present with dyspnea, but distinguishing malignant from infectious airway obstruction is difficult. Long-lasting dyspnea with no fever or tenderness to palpation from larynx movement may be an oncologic emergency. CT with coronal and sagittal reformations can help identify the cause, site, and severity of airway obstructions for airway management.

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