Presentation, Diagnosis, and Management of Subglottic and Tracheal Stenosis During Systemic Inflammatory Diseases.
Adult
Amyloidosis
/ complications
Calcinosis
/ diagnosis
Crohn Disease
/ complications
Female
Glucocorticoids
/ therapeutic use
Granulomatosis with Polyangiitis
/ complications
Humans
Immunosuppressive Agents
/ therapeutic use
Laryngoscopy
/ methods
Laryngostenosis
/ diagnosis
Male
Methotrexate
/ therapeutic use
Middle Aged
Polychondritis, Relapsing
/ complications
Retrospective Studies
Sarcoidosis
/ complications
Skin Diseases, Vesiculobullous
/ complications
Tomography, X-Ray Computed
Tracheal Stenosis
/ diagnosis
subglottic stenosis
systemic diseases
tracheobronchial involvement
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
04
01
2021
revised:
12
07
2021
accepted:
13
07
2021
pubmed:
30
7
2021
medline:
22
2
2022
entrez:
29
7
2021
Statut:
ppublish
Résumé
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. What are the inflammatory etiologies of SGS and TS, and what are their characteristics and prognosis? This multicenter, observational retrospective study was performed in patients with SGS or TS that was neither traumatic nor tumoral. 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, RP-related 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. 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.
Sections du résumé
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, RP-related 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.
Identifiants
pubmed: 34324839
pii: S0012-3692(21)01391-X
doi: 10.1016/j.chest.2021.07.037
pii:
doi:
Substances chimiques
Glucocorticoids
0
Immunosuppressive Agents
0
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
257-265Informations de copyright
Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.