食道癌のリンパ節転移による気管狭窄の3例

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タイトル別名
  • Tracheal Stenosis due to Metastatic Lymph Nodes from Esophageal Carcinoma
  • ショクドウガン ノ リンパセツ テンイ ニヨル キカン キョウサク ノ 3レイ

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Three Cases of tracheal stencsis due to metastasis to paratracheal and paraesophageal lymphnodes from esophageal carcinoma were reported.<BR>Though the most common symptom associated with esophageal carcinoma is dysphagia, chiefcomplain of the 3 cases was dyspnea followed by hoarseness. When patients have dyspneawithout dysphagia, it is usually delayed to be diagnosed esophageal carcinoma, because trachealobstruction is a life-threatening emergeney that requires immediate therapy.<BR>The first patient had dyspnea and hemoptysis followed by hoarseness. Bronchoscopic examinationdisclosed carcinoma which occluded the lumen of the mid-trachea. Nine tracheal ringswere resected and a primary anastomosis was carried out. After operation, esophagographyshowed filling defect of middle third of esophagus due to carcinoma.<BR>The second patient complained of worsening dyspnea and hemoptysis followed by hoarseness.A tracheostomy was carried out immediately, and a tracheal tube was inserted. Tomogramsconfirmed tracheal narrowing above the carina, so diagnosed the mediastinal tumor that compressedthe frachea. An emergency operation to excise the tumor was performed. Microscopic examinationshowed that the tumors was metastatic lymph nodes of squamous cell carcinoma.After operation, esophagography showed filling defect of lower esophagus due to carcincma.<BR>The third patient was admitted for dyspnea and dysphagia followed by hoarseness. Bronchoscopyshowed a circumferential constriction 5 cm below the cords. Dyspnea was not so severethat he received 6000 rads of Linac. Brushing the lumen of the pcsterior wall of the occludedtrachea yielded the diagnosis of squamous cell carcincma. Esophagography showed stenosis ofmiddle third of esophagus due to carcinoma.<BR>The first presenting symptom was hoarseness, but at that time they were diagnosed as idiopathic paralysis of recurrent laryngeal nerve. When paralysis of recurrent laryngeal nerveappears, the true cause must be sought for by means of chest x-ray film, tomography and endoscopic examination of the trachea and esophagus.

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