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doi:10.1378/chest.06-2301
(Chest. 2007; 131:1114-1117)
© 2007 American College of Chest Physicians
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Tracheobronchial Laceration After Balloon Dilation for Benign Strictures*

Incidence and Clinical Significance

Jin Hyoung Kim, MD; Ji Hoon Shin, MD; Ho-Young Song, MD; Tae Sun Shim, MD; Gi-Young Ko, MD; Hyun-Ki Yoon, MD and Kyu-Bo Sung, MD

* From the Departments of Radiology (Drs. Kim, Shin, Song, Ko, Yoon, and Sung) and Internal Medicine (Dr. Shim), Division of Pulmonology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Correspondence to: Ji Hoon Shin, MD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388–1, Pungnap-2dong, Songpa-gu, Seoul 138–736, Korea; e-mail: jhshin{at}amc.seoul.kr

Abstract

Background: Although balloon dilation is a safe procedure, it can lead to laceration of the airway, causing bleeding, pneumothorax, pneumomediastinum, or mediastinitis. We therefore determined the incidence and clinical significance of tracheobronchial lacerations after balloon dilation for treatment of benign tracheobronchial strictures.

Methods: We evaluated 97 patients who had undergone balloon dilation in 124 sessions for the treatment of benign tracheobronchial strictures. The degree of airway laceration was evaluated bronchoscopically. The cumulative airway patency rate after balloon dilation was compared in patients with and without lacerations using Kaplan-Meier survival curves and log-rank testing.

Results: There were 64 tracheobronchial lacerations (51.6%) during the 124 sessions of balloon dilation. Of these, 60 were superficial and 4 were deep, but there were no incidents of transmural laceration. In patients with lacerations, mild chest pain (n = 5), blood-tinged sputum (n = 21), and pneumomediastinum (n = 2) occurred, but all resolved completely within 24 h. All superficial lacerations healed spontaneously within 1 month, and all deep lacerations healed 2 to 9 months after conservative treatment. During the follow-up period, the median cumulative airway patency period in patients with and without lacerations was 24 and 4 months (p < 0.05), respectively.

Conclusion: Laceration secondary to balloon dilation in the tracheobronchial tree is relatively common but rarely progresses to transmural laceration and may improve patency outcomes.

Key Words: airway • airway strictures • balloon dilation • bronchoscopy • trauma






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