large airway obstruction may be due to intraluminal disease , stenosis , tracheobronchial collapse and extinsic compression . surgical resection and anastomosis is the accepted approach to short focal airway disease . in many cases
this may not be feasible because of the site and extent of the stenosis , the cause of the underlying disease and the general state of the patient .
nonsurgical palliative methods have been developed and include laser photocoagulation , balloon dilatation , cryotherapy , alcohol injection therapy and prosthesis .
so , another palliative treatment method , self - expandable metallic stent , was used in the narrowed airway where surgical resection is inadvisable .
this procedure had been also performed successfully in tuberculous bronchial stenosis that does not respond to medical therapy .
after insertion of stents in the large airway , previous reported short - term complications are granuloma formation , stent migration , localized inflammation , fatal massive hemoptysis , wall perforation and respiratory distress . to our best knowlege
, there was no report about long - term complication after stent insertion in tuberculous bronchial stenosis .
a 29-year - old woman had had left pleuritic chest pain and dyspnea for 6 months .
three years earlier , bronchoscopic examination revealed focal narrowing of the left main bronchus with severe fibrotic changes suggestive of sequelae of endobronchial tuberculosis .
but her symptoms increased over the next 2 months , and it was believed that further treatment was needed for her stenosis .
after the procedure , her clinical symptoms were improved . however , 30 months after stent placement , dyspnea on exertion developed and we noted obstruction at the site of the metallic stent by bronchoscopic examination . on physical examination ,
bronchoscopic examination revealed total obstruction of left main bronchus with granuloma - appeared polypoid mass and proximal portion of migrated metallic stents ( fig .
pulmonary function tests showed the forced expiratory volume in 1s ( fev1 ) of 0.74l(26% of predicted ) , fev1/fvc 50% , the forced vital capacity ( fvc ) for 1.48l ( 41% of predicted ) .
resection of the left lung , inclunding the stenotic segments of the left bronchus , was performed .
after operation , her pulmonary function tests shows fev1 , of 1.32l ( 48% of predicted ) , fev1/fvc 68% , fvc for 1.80l ( 50% of predicted ) . in resected specimen ,
biopsy finding of left main bronchus shows granulomatous inflammation by foreign body reaction which is composed of epithelioid cells and lymphocyte . at 6 months after the operation ,
techuiques used to treat bronchial stenosis include surgical resection , cryotherapy , laser photo - resection and balloon dilatation .
balloon dilatation to treat tuberculous bronchial stenosis was first reported in english literature by nakamura et al .
balloon dilatation is easier to perform , less invasive and less costly than surgery , but complications such as restenosis , bleeding , airway rupture and acquired bronchomalacia frequently occur .
another palliative method is insertion of rigid silicone t tube ( montgomery ) but this type of prosthesis is poorly tolerated historically .
the other palliative method , self - expandible prosthesis , nas introduced in the narrowed airway where surgical resection is inadvisable .
after the first use of gianturco self - expanding metallic stents in the vascular and biliary systems , an expandable stainless steel stent was formulated for use in bronchogenic tumor , postoperative stenosis , tracheomalacia and airway collapse following tracheal reconstruction , relapsing polychondritis and stenosis in secondary lung transplantation .
the stent can restore the patency of the airway promptly and supports the airway against increased thoracic pressure during expiration , in one physiolgic study , fvc increased fron 64% predicted to 73% predicted , fev1 from 49% predicted to 72% predicted , and the ratio of the fev1/fvc from 59% predicted to 78% predicted after tracheobronchial stents insertion .
the advantage of the self - expandig metallic stent is that it can be used with the patient under local anesthesia , it is easy to perform and does not occlude tributaries of the airway , even if the stents override the opening of the branches of the airways .
the complications are granuloma formation , stent migration , localized inflammation , dysphagia , suction catheter entrapment , fatal massive hemoptysis , rupture of the metallic mesh , obstruction , wall perforation and respiratory distress .
the most frequently recovered isolates in granulation tissue were streptococci viridans , pseudomonas aeruginosa , nonhemolytic streptococcus , staphylococcus aureus . in tuberculous bronchial stenosis
, expandable metallic stent is used if restenosis occurs after several attempts with balloon dilatation . the first case of successful tueatment with gianturco self - expanding metallic stents in tuberculous bronchial stenosis
we had successfully treated one patient with tuberculous bronchial stenosis with a gianturco - type stent .
the dyspnea on exertion was developed and we notified the obstruction at the site of the metallic stent by bronchoscopic examination .
the self - expanding metallic stent was introduced as a good method in tuberculous bronchial stenosis .
however , expandible metallic stent does not seem to be safe in the treatment of endobronchial tuberculosis in the long - term effect .
 expandable metallic stents seemed to be a good method in tuberculous bronchial stenosis that does not respond to medical therapy . 
 but there was no long - term follow - up study after stents insertion in tuberculous bronchial stenosis . 
 we report a case of obstruction after successful gianturco metallic stents insertion due to tuberculous bronchial stenosis . 
INTRODUCTION
CASE REPORT
DISCUSSION