Unique application of awake tracheoscopy and endobronchial ultrasound in the management of tracheal mucoepidermoid carcinoma.

Abstract

Mucoepidermoid carcinoma of the trachea is a rare pediatric malignancy that presents unique challenges in diagnosis, operative management, and surveillance. We present a 17-year-old girl with primary tracheal mucoepidermoid carcinoma presenting in acute respiratory distress due to near-total occlusion of the tracheal airway. An algorithmic approach to preoperative planning was developed to evaluate and remove the tumor endoscopically without compromising oxygenation. After initial palliative resection, endobronchial ultrasound was uniquely applied to evaluate depth of tumor invasion, and subsequent tracheal resection with primary anastomosis was performed as curative treatment. Removal of distal tracheal masses can be performed safely with the implementation of an algorithmic approach to tumor visualization and resection. Endobronchial ultrasound can be used to evaluate the extent of tumor invasion and plan for definitive resection.