Metallic stents for rescuing a patient with severe upper airway compression due to aortic aneurysm

Aortic aneurysm is usually a potentially life-threatening medical problem, with a 5-year survival rate of 20% if there is no surgical repair. Upper airway compression due to aortic aneurysm usually presents with wheezing, coughing, hemoptysis, dyspnea, or pneumonitis. We report a 78-year-old male patient with a history of chronic obstructive pulmonary disease who was admitted to our emergency department because of wheezing dyspnea for 2 days. Acute chronic obstructive pulmonary disease exacerbation with respiratory failure was impressed, but the patient had poor response to bronchodilators and systemic steroids treatment. Because chest radiography revealed a widening of the upper mediastinum and right lower lung collapse, fiberoptic bronchoscopy was performed and revealed narrowing at the lower portion of trachea and orifice of right main bronchus. Chest computed tomography scan showed aortic aneurysm involving the aortic arch and near the entire thoracic aorta. Because of his poor condition, surgery for aortic aneurysm was not suggested by the thoracic surgeons. We deployed expandable metallic stents in the right main stem bronchi and in the distal trachea. The patient was then weaned from mechanical ventilation a few days later.