Thoracic Emergencies: Tracheobronchial, Pulmonary, and Pleural Diseases

  • Loretta Erhunmwunsee
  • Dan J. Raz


Emergencies that affect the airway, including obstruction and hemoptysis, are potentially life threatening and can have etiologies unique to cancer patients. Several additional urgent problems, including pneumothorax and pleural effusions, are commonly encountered in the cancer patient. In this chapter, we examine the causes, evaluation, and treatment of tracheobronchial, pulmonary, and pleural disease, focusing specifically on conditions commonly seen in cancer patients.


Tracheal tumors Tracheal obstruction Tracheoesophageal fistula Hemoptysis Pneumothorax Chylothorax Pleural effusion 


  1. 1.
    Grillo HC, Donahue DM. Postintubation tracheal stenosis. Chest Surg Clin N Am. 1996;6(4):725–31.PubMedGoogle Scholar
  2. 2.
    Grillo HC. The history of tracheal surgery. Chest Surg Clin N Am. 2003;13(2):175–89.CrossRefPubMedGoogle Scholar
  3. 3.
    Grillo HC, Mathisen DJ. Primary tracheal tumors: treatment and results. Ann Thorac Surg. 1990;49(1):69–77.CrossRefPubMedGoogle Scholar
  4. 4.
    Gaissert HA, Honings J, Grillo HC, Donahue DM, Wain JC, Wright CD, Mathisen DJ. Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma. Ann Thorac Surg. 2007;83(6):1952–9. doi: 10.1016/j.athoracsur.2007.01.056.CrossRefPubMedGoogle Scholar
  5. 5.
    Gaissert HA, Grillo HC, Shadmehr MB, Wright CD, Gokhale M, Wain JC, Mathisen DJ. Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina. Ann Thorac Surg. 2004;78(6):1889–96. doi: 10.1016/j.athoracsur.2004.05.064. discussion 1896–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Hurtgen M, Herber SC. Treatment of malignant tracheoesophageal fistula. Thorac Surg Clin. 2014;24(1):117–27. doi: 10.1016/j.thorsurg.2013.09.006.CrossRefPubMedGoogle Scholar
  7. 7.
    Muniappan A, Wain JC, Wright CD, Donahue DM, Gaissert H, Lanuti M, Mathisen DJ. Surgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg. 2013;95(4):1141–6. doi: 10.1016/j.athoracsur.2012.07.041.CrossRefPubMedGoogle Scholar
  8. 8.
    Dedo HH, Fishman NH. Laryngeal release and sleeve resection for tracheal stenosis. Ann Otol Rhinol Laryngol. 1969;78(2):285–96.CrossRefPubMedGoogle Scholar
  9. 9.
    Grillo HC. Tracheal replacement. J Thorac Cardiovasc Surg. 2003;125(4):975. doi: 10.1067/mtc.2003.260.CrossRefPubMedGoogle Scholar
  10. 10.
    Yendamuri S. Massive airway hemorrhage. Thorac Surg Clin. 2015;25(3):255–60. doi: 10.1016/j.thorsurg.2015.04.009.CrossRefPubMedGoogle Scholar
  11. 11.
    Yoon W, Kim JK, Kim YH, Chung TW, Kang HK. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics. 2002;22(6):1395–409. doi: 10.1148/rg.226015180.CrossRefPubMedGoogle Scholar
  12. 12.
    Dweik RA, Stoller JK. Role of bronchoscopy in massive hemoptysis. Clin Chest Med. 1999;20(1):89–105.CrossRefPubMedGoogle Scholar
  13. 13.
    Shao H, Wu J, Wu Q, Sun X, Li L, Xing Z, Sun H. Bronchial artery embolization for hemoptysis: a retrospective observational study of 344 patients. Chin Med J (Engl). 2015;128(1):58–62. doi: 10.4103/0366-6999.147811.CrossRefGoogle Scholar
  14. 14.
    Swanson KL, Johnson CM, Prakash UB, McKusick MA, Andrews JC, Stanson AW. Bronchial artery embolization: experience with 54 patients. Chest. 2002;121(3):789–95.CrossRefPubMedGoogle Scholar
  15. 15.
    Chun JY, Morgan R, Belli AM. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization. Cardiovasc Intervent Radiol. 2010;33(2):240–50. doi: 10.1007/s00270-009-9788-z.CrossRefPubMedGoogle Scholar
  16. 16.
    Reinfuss M, Mucha-Malecka A, Walasek T, Blecharz P, Jakubowicz J, Skotnicki P, Kowalska T. Palliative thoracic radiotherapy in non-small cell lung cancer. An analysis of 1250 patients. Palliation of symptoms, tolerance and toxicity. Lung Cancer. 2011;71(3):344–9. doi: 10.1016/j.lungcan.2010.06.019.CrossRefPubMedGoogle Scholar
  17. 17.
    Wu GX, Khojabekyan M, Wang J, Tegtmeier BR, O'Donnell MR, Kim JY, Grannis FW, Raz DJ. Survival following lung resection in immunocompromised patients with pulmonary invasive fungal infection. Eur J Cardiothorac Surg. 2016;49(1):314–20. doi: 10.1093/ejcts/ezv026.CrossRefPubMedGoogle Scholar
  18. 18.
    Muniappan A, Tapias LF, Butala P, Wain JC, Wright CD, Donahue DM, Gaissert HA, Lanuti M, Mathisen DJ. Surgical therapy of pulmonary aspergillomas: a 30-year North American experience. Ann Thorac Surg. 2014;97(2):432–8. doi: 10.1016/j.athoracsur.2013.10.050.CrossRefPubMedGoogle Scholar
  19. 19.
    Pilling JE, Dusmet ME, Ladas G, Goldstraw P. Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol. 2010;5(10):1544–50. doi: 10.1097/JTO.0b013e3181e95cb8.CrossRefPubMedGoogle Scholar
  20. 20.
    Heffner JE, Klein JS. Recent advances in the diagnosis and management of malignant pleural effusions. Mayo Clin Proc. 2008;83(2):235–50. doi: 10.4065/83.2.235.CrossRefPubMedGoogle Scholar
  21. 21.
    Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ, BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii32–40. doi: 10.1136/thx.2010.136994.CrossRefPubMedGoogle Scholar
  22. 22.
    Morgensztern D, Waqar S, Subramanian J, Trinkaus K, Govindan R. Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small-cell lung cancer. J Thorac Oncol. 2012;7(10):1485–9. doi: 10.1097/JTO.0b013e318267223a.CrossRefPubMedGoogle Scholar
  23. 23.
    van Galen KP, Visser HP, van der Ploeg T, Smorenburg CH. Prognostic factors in patients with breast cancer and malignant pleural effusion. Breast J. 2010;16(6):675–7. doi: 10.1111/j.1524-4741.2010.00986.x.CrossRefPubMedGoogle Scholar
  24. 24.
    Stather DR, Tremblay A. Use of tunneled pleural catheters for outpatient treatment of malignant pleural effusions. Curr Opin Pulm Med. 2007;13(4):328–33. doi: 10.1097/MCP.0b013e328121447d.CrossRefPubMedGoogle Scholar
  25. 25.
    Suzuki K, Servais EL, Rizk NP, Solomon SB, Sima CS, Park BJ, Kachala SS, Zlobinsky M, Rusch VW, Adusumilli PS. Palliation and pleurodesis in malignant pleural effusion: the role for tunneled pleural catheters. J Thorac Oncol. 2011;6(4):762–7. doi: 10.1097/JTO.0b013e31820d614f.CrossRefPubMedGoogle Scholar
  26. 26.
    Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med. 1994;120(1):56–64.CrossRefPubMedGoogle Scholar
  27. 27.
    Rehse DH, Aye RW, Florence MG. Respiratory failure following talc pleurodesis. Am J Surg. 1999;177(5):437–40.CrossRefPubMedGoogle Scholar
  28. 28.
    Arapis K, Caliandro R, Stern JB, Girard P, Debrosse D, Gossot D. Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients. Surg Endosc. 2006;20(6):919–23. doi: 10.1007/s00464-005-0534-6.CrossRefPubMedGoogle Scholar
  29. 29.
    de Campos JR, Vargas FS, de Campos WE, Cardoso P, Teixeira LR, Jatene FB, Light RW. Thoracoscopy talc poudrage: a 15-year experience. Chest. 2001;119(3):801–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, Davies CW, Grayez J, Harrison R, Prasad A, Crosthwaite N, Lee YC, Davies RJ, Miller RF, Rahman NM. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012;307(22):2383–9. doi: 10.1001/jama.2012.5535.CrossRefPubMedGoogle Scholar
  31. 31.
    Dresler CM, Olak J, Herndon II JE, Richards WG, Scalzetti E, Fleishman SB, Kernstine KH, Demmy T, Jablons DM, Kohman L, Daniel TM, Haasler GB, Sugarbaker DJ, Cooperative Groups C and Leukemia Group B, Eastern Cooperative Oncology G, North Central Cooperative Oncology G, Radiation Therapy Oncology G. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest. 2005;127(3):909–15. doi: 10.1378/chest.127.3.909.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Chang YT, Dai ZK, Kao EL, Chuang HY, Cheng YJ, Chou SH, Huang MF. Early video-assisted thoracic surgery for primary spontaneous hemopneumothorax. World J Surg. 2007;31(1):19–25. doi: 10.1007/s00268-006-0354-4.CrossRefPubMedGoogle Scholar
  33. 33.
    Doerr CH, Miller DL, Ryu JH. Chylothorax. Semin Respir Crit Care Med. 2001;22(6):617–26. doi: 10.1055/s-2001-18797.CrossRefPubMedGoogle Scholar
  34. 34.
    Dumont AE, Mayer DJ, Mulholland JH. The suppression of immunologic activity by diversion of thoracic duct lymph. Ann Surg. 1964;160:373–83.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Franksson C, Lundgren G, Magnusson G, Ringden O. Drainage of thoracic duct lymph in renal transplant patients. Transplantation. 1976;21(2):133–40.CrossRefPubMedGoogle Scholar
  36. 36.
    Browse NL, Allen DR, Wilson NM. Management of chylothorax. Br J Surg. 1997;84(12):1711–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Epaud R, Dubern B, Larroquet M, Tamalet A, Guillemot N, Maurage C, Clement A, Fauroux B. Therapeutic strategies for idiopathic chylothorax. J Pediatr Surg. 2008;43(3):461–5. doi: 10.1016/j.jpedsurg.2007.10.024.CrossRefPubMedGoogle Scholar
  38. 38.
    Marts BC, Naunheim KS, Fiore AC, Pennington DG. Conservative versus surgical management of chylothorax. Am J Surg. 1992;164(5):532–4. discussion 534–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Zabeck H, Muley T, Dienemann H, Hoffmann H. Management of chylothorax in adults: when is surgery indicated? Thorac Cardiovasc Surg. 2011;59(4):243–6. doi: 10.1055/s-0030-1250374.CrossRefPubMedGoogle Scholar
  40. 40.
    Tsai WK, Chen W, Lee JC, Cheng WE, Chen CH, Hsu WH, Shih CM. Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults. Am J Emerg Med. 2006;24(7):795–800. doi: 10.1016/j.ajem.2006.04.006.CrossRefPubMedGoogle Scholar
  41. 41.
    Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg. 2010;139(3):584–9. doi: 10.1016/j.jtcvs.2009.11.025. discussion 589–90.CrossRefPubMedGoogle Scholar
  42. 42.
    Kawasaki R, Sugimoto K, Fujii M, Miyamoto N, Okada T, Yamaguchi M, Sugimura K. Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: correlation with radiologic findings and preceding medical treatment. AJR Am J Roentgenol. 2013;201(3):659–66. doi: 10.2214/AJR.12.10008.CrossRefPubMedGoogle Scholar
  43. 43.
    Mincher L, Evans J, Jenner MW, Varney VA. The successful treatment of chylous effusions in malignant disease with octreotide. Clin Oncol. 2005;17(2):118–21.CrossRefGoogle Scholar
  44. 44.
    Stein ME, Shklar Z, Drumea K, Goralnik L, Ben-Arieh Y, Haim N. Chemotherapy-induced spontaneous pneumothorax in a patient with bulky mediastinal lymphoma: a rare oncologic emergency. Oncology. 1997;54(1):15–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Chen CH, Liao WC, Liu YH, Chen WC, Hsia TC, Hsu WH, Shih CM, Tu CY. Secondary spontaneous pneumothorax: which associated conditions benefit from pigtail catheter treatment? Am J Emerg Med. 2012;30(1):45–50. doi: 10.1016/j.ajem.2010.09.014.CrossRefPubMedGoogle Scholar
  46. 46.
    Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, Luketich JD, Panacek EA, Sahn SA, Group APC. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119(2):590–602.CrossRefPubMedGoogle Scholar
  47. 47.
    Light RW, O’Hara VS, Moritz TE, McElhinney AJ, Butz R, Haakenson CM, Read RC, Sassoon CS, Eastridge CE, Berger R, et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs cooperative study. JAMA. 1990;264(17):2224–30.CrossRefPubMedGoogle Scholar
  48. 48.
    Chambers A, Routledge T, Bille A, Scarci M. Is blood pleurodesis effective for determining the cessation of persistent air leak? Interact Cardiovasc Thorac Surg. 2010;11(4):468–72. doi: 10.1510/icvts.2010.234559.CrossRefPubMedGoogle Scholar
  49. 49.
    Cagirici U, Sahin B, Cakan A, Kayabas H, Buduneli T. Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. Scand Cardiovasc J. 1998;32(2):75–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of SurgeryCity of Hope National Medical CenterDuarteUSA
  2. 2.Department of SurgeryCity of HopeDuarteUSA

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