Presentation, Diagnosis, and Management of Subglottic and Tracheal Stenosis During Systemic Inflammatory Diseases

被引：17

作者：

Catano, Jennifer ^{[1
]}

Uzunhan, Yurdagul ^{[2
]}

Paule, Romain ^{[3
]}

Dion, Jeremie ^{[4
]}

Regent, Alexis ^{[1
]}

Legendre, Paul ^{[1
]}

Gonin, Francois ^{[5
]}

Martinod, Emmanuel ^{[6
]}

Cohen, Pascal ^{[1
]}

Puechal, Xavier ^{[1
]}

Le Guern, Veronique ^{[1
]}

Mouthon, Luc ^{[1
]}

Coste, Andre ^{[7
]}

Lorut, Christine ^{[8
]}

La Croix, Candice ^{[9
]}

Perie, Sophie ^{[10
]}

Terrier, Benjamin ^{[1
]}

机构：

[1] Ctr Univ Paris CUP, Hop Cochin, AP HP, Dept Internal Med,Natl Referral Ctr Rare Autoimmu, Paris, France

[2] Univ Paris Nord, Hop Avicenne, AP HP, INSERM,U1272,Dept Pneumol,Reference Ctr Rare Pulm, Bobigny, France

[3] Hop Foch, Dept Internal Med, Suresnes, France

[4] Oncopole, Dept Clin Immunol, Toulouse, France

[5] Hop Foch, Dept Thorac Surg, Suresnes, France

[6] Hop Avicenne, AP HP, Dept Thorac Surg, Bobigny, France

[7] Hop Intercommunal Creteil, Dept Otolaryngol, Creteil, France

[8] Hop Cochin, Dept Pneumol, Paris, France

[9] Hop Cochin, Dept Otolaryngol, Paris, France

[10] Clin Hartmann, Dept Otolaryngol, Neuilly Sur Seine, France

来源：

CHEST | 2022年 / 161卷 / 01期

关键词：

subglottic stenosis; systemic diseases; tracheobronchial involvement; IDIOPATHIC LARYNGOTRACHEAL STENOSIS; RELAPSING POLYCHONDRITIS; GRANULOMATOSIS; VASCULITIS; WEGENERS;

D O I：

10.1016/j.chest.2021.07.037

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: Subglottic stenosis (SGS) and tracheal stenosis (TS) are characterized by a narrowing of the airways. The goal of this study was to describe the characteristics and prognosis of nontraumatic and nontumoral SGS or TS. RESEARCH QUESTION: What are the inflammatory etiologies of SGS and TS, and what are their characteristics and prognosis? STUDY DESIGN AND METHODS: This multicenter, observational retrospective study was performed in patients with SGS or TS that was neither traumatic nor tumoral. RESULTS: Eighty-one patients were included, 33 (41%) with granulomatosis with polyangiitis (GPA) and 21 (26%) with relapsing polychondritis (RP). GPA-related stenoses exhibited circumferential subglottic narrowing in 85% of cases, without calcifications. In contrast, RPrelated stenoses displayed anterior involvement in 76%, in a longer distance from vocal cords (4 cm), with calcifications in 62%, and extension to bronchi in 86%. Other diagnoses included bullous dermatoses (n = 3), amyloidosis (n = 3), sarcoidosis (n = 2), and Crohn's disease (n = 2); the remaining stenoses (n = 15) were idiopathic. SGS/TS was the initial manifestation of the disease in 66% of cases, with a median interval from stenosis to disease diagnosis of 12 months (interquartile range, 0-48 months). Despite the use of glucocorticoids in 80%, combined with methotrexate in 49%, endoscopic procedures were required in 68% of patients. Relapses of stenoses occurred in 76% without any difference between causes (82% in GPA, 67% in RP, and 75% in idiopathic SGS/TS). Three patients died due to the stenosis, two of RP and one of GPA. INTERPRETATION: These data show that GPA and RP are the two main inflammatory diseases presenting with SGS/TS. GPA-related stenoses are mostly subglottic and circumferential, whereas RP-related stenoses are mostly tracheal, anterior, and calcified with a frequent extension to bronchi. Relapses of stenoses are common, and relapse rates do not differ between causes. Diagnosis and management of SGS/TS require a multidisciplinary approach.

引用

页码：257 / 265

页数：9

共 30 条

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