Bronchoscopic management of near-complete malignant tracheal obstruction secondary to recurrent papillary thyroid carcinoma using multimodality therapeutic bronchoscopy – a case report

Background Papillary thyroid carcinoma has a favorable prognosis; however, recurrent or locally invasive disease may rarely involve the trachea and cause critical airway obstruction. Therapeutic bronchoscopy with tumor debulking and airway stenting can provide rapid airway restoration in selected patients with malignant central airway obstruction. Case presentation A 55-year-old man with a history of papillary thyroid carcinoma treated with thyroidectomy and adjuvant radioactive iodine-131 ablation therapy presented with progressive shortness of breath, stridor, orthopnea, reduced exercise tolerance and intermittent hemoptysis. Oxygen saturation was 88% on room air and examination revealed audible inspiratory stridor. CT imaging demonstrated a heterogeneously enhancing solid mass arising from the left side of the trachea with tracheal wall invasion and severe airway narrowing. Flexible bronchoscopy showed a friable lesion occluding the tracheal lumen. Urgent rigid bronchoscopy was performed under general anesthesia. Argon plasma coagulation was applied to reduce tumor vascularity, followed by cryodebulking and deployment of a fully-covered self-expanding metallic (SEMS) nitinol tracheal stent. Histopathology and immunohistochemistry confirmed recurrent papillary thyroid carcinoma. Four-week follow-up confirmed satisfactory stent position and airway patency. Conclusion This case demonstrates the feasibility of urgent therapeutic bronchoscopy for immediate airway stabilization and short-term symptomatic improvement and its potential as a bridge to further oncological treatment in selected patients with recurrent papillary thyroid carcinoma causing malignant tracheal obstruction.