case_images: PMC10944989_01
case_images: Chest CT imaging on airway structural changes before and after treatment. (A, D) Airway wall thickening, necrosis and luminal obstruction before treatment. (B, E) Airway patency after the placement of airway stent. (C, F) Improvement of tracheal wall thickening and luminal narrowing after interventional treatment with airway stent withdraw.
case_images: fcimb-14-1366472-g001.jpg
case_images: PMC10944989_01_fcimb-14-1366472-g001.jpg
case_images: f1
case_images: CT and bronchoscopy suggested extensive mucosal necrosis with granulation tissue formation and significant luminal narrowing in the middle and upper trachea ( Figures 1A, D ,  2A, B ). Considering the mucosal necrosis and granulation tissue formation had induced to severe tracheal stenosis, a covered metallic stent was urgently implanted to relieve airway obstruction ( Figures 1B, E ,  2C ). Chest CT and bronchoscopy follow-up were performed after 1 month, showing a gradual reduction of mucosal necrotic tissue in the airway, as well as an improvement of the tracheal wall thickening ( Figures 1C, F ,  2C ). After 3 months of treatment, the tracheal metallic stent was removed, the bronchoscopy revealed a patent airway with a small amount of granulation tissue and an intact tracheal mucosa repair without necrotic adherence ( Figures 1C, F ,  2F ).
case_images: Bronchoscopic finding of tracheal Rhizopus Oryzae infection before and after treatment. (A, B) Tracheal mucosal necrosis, granulation tissue proliferation and severe airway necrosis before treatment. (C) Airway stent placement to maintain luminal patency. (D) Patient did not respond to intravenous amphotericin B treatment, airway necrosis and airway obstruction recurred. (E) Topically dripping amphotericin B between the stent and tracheal wall by microtubule via bronchoscope. (F) Patent airway with a small amount of granulation tissue and an intact tracheal mucosa repair without necrotic adherence.
case_images: fcimb-14-1366472-g002.jpg
case_images: PMC10944989_01_fcimb-14-1366472-g002.jpg
case_images: f2
case_images: CT and bronchoscopy suggested extensive mucosal necrosis with granulation tissue formation and significant luminal narrowing in the middle and upper trachea ( Figures 1A, D ,  2A, B ). Considering the mucosal necrosis and granulation tissue formation had induced to severe tracheal stenosis, a covered metallic stent was urgently implanted to relieve airway obstruction ( Figures 1B, E ,  2C ). Whereas, the one-month CT reexamination demonstrated no change in tracheal wall thickening and luminal stenosis, whilst, the bronchoscopy unexpectedly revealed the progressive development of mucosal necrosis and severe airway obstruction ( Figure 2D ). In an attempt to enhance the drug penetration to the tracheal lesion, amphotericin B (5mg, mixed with saline 20ml) was topically dripped between the stent and tracheal wall by microtubule via bronchoscope once a week ( Figure 2E ), which might be conducive to prolonging the contact time of the anti-fungal administration. Chest CT and bronchoscopy follow-up were performed after 1 month, showing a gradual reduction of mucosal necrotic tissue in the airway, as well as an improvement of the tracheal wall thickening ( Figures 1C, F ,  2C ). After 3 months of treatment, the tracheal metallic stent was removed, the bronchoscopy revealed a patent airway with a small amount of granulation tissue and an intact tracheal mucosa repair without necrotic adherence ( Figures 1C, F ,  2F ).