THE TREATMENT OF TRACHEOBRONCHOMEGALY USI NG FREITAGS PROSTHESIS

Tracheobronchomegaly (TBM) is a rare disorder. Ir is characterised by a dilatation of rile trachea and subsequent bronchial divisions associ ated with a dynamic pathology, in particular a cough which explains th e symptomatology of the patients. We report the observation of a patie nt suffering from TBM whose clinical yi-ogress rapidly improved after the insertion of a Freitag prosthesis. This 60-year-old male presented with a year's history, of chronic cough which was painful, cavernous and had been incapacitating associated with moderate dyspnoea of effor t. Bronchial endoscopy showed dyskinesia extending almost totally thro ughout the tracheobronchial tree with complete expiratory collapse. Th e FEVI, the Vital Capacity and the TLC were subnormal and the PEF was 57% of the predicted. The total airways resistance (RAW) was elevated (306% of the predicted), the arterial blood gases were normal. A CT sc an showed a deformed trachea with increased diameter. A tracheobronchi al prosthesis of Freitag or Dynamic stent (Rusch) was inserted with th e help of a rigid bronchoscope. One month later the cough had regresse d and the effort dyspnoea had disappeared. One year Inter rite clinica l improvement persisted with very good tolerance of rite prosthesis wi th normal spirometry despite the persistence of art elevated RAW Despi te a recoil which is still imperfect the tracheobronchial endoprosthes is seems to be a useful treatment for forms of TBM which are potential ly progressive.