[Treatment of tracheobronchomegaly using the Freitag prosthesis]

Tracheobronchomegaly (TBM) is a rare disorder. It is characterised by a dilatation of the trachea and subsequent bronchial divisions associated with a dynamic pathology, in particular a cough which explains the symptomatology of the patients. We report the observation of a patient suffering from TBM whose clinical progress rapidly improved after the insertion of a Freitag prosthesis. This 60-year-old male presented with a year's history of chronic cough which was painful, cavernous and had been incapacitating associated with moderate dyspnoea of effort. Bronchial endoscopy showed dyskinesia extending almost totally throughout the tracheobronchial tree with complete expiratory collapse. The FEV1, the Vital Capacity and the TLC were subnormal and the PEF was 57% of the predicted. The total airways resistance (RAW) was elevated (306% of the predicted), the arterial blood gases were normal. A CT scan showed a deformed trachea with increased diameter. A tracheobronchial prosthesis of Freitag or Dynamic stent (Rüsch) was inserted with the help of a rigid bronchoscope. One month later the cough had regressed and the effort dyspnoea had disappeared. One year later the clinical improvement persisted with very good tolerance of the prosthesis with normal spirometry despite the persistence of an elevated RAW. Despite a recoil which is still imperfect the tracheobronchial endoprosthesis seems to be a useful treatment for forms of TBM which are potentially progressive.