Tracheal Perforation following Chemotherapy of Diffuse Large B-Cell Lymphoma

Tracheal perforation is a rare and life-threatening complication following the treatment of lymphoma. There are only a few published cases of tracheal disruption from invasive lymphoma, and most of the patients did not survive. Tumor erosion and nodal necrosis from rapid tumor growth or chemotherapeutic response can cause tracheal disruption. We report here a case of tracheal perforation after chemotherapy of lymphoma. A 69-year-old Thai man presented with upper airway obstruction from a large neck mass encasing and invading the trachea. The patient was intubated to bypass the tracheal obstruction. Biopsy of the mass showed diffuse large B-cell lymphoma. Chemotherapy was urgently administered. Two days after treatment, the patient developed acute respiratory distress with high airway resistance. Emergency bronchoscopy and chest computerized tomography revealed disrupted anterior wall of trachea and endotracheal tube displacement, which created a false track into the mass. Tumor necrosis was thought to be the cause of this perforation and tube malposition. The tube was repositioned by bronchoscopic guidance. Unfortunately, the disrupted trachea could not be reconstructed. Palliative care was consequently provided, and the patient finally passed away a week after the catastrophic event. This report demonstrates clinical presentation, chest imaging, and bronchoscopic findings of tracheal perforation, which is a rare complication following the treatment of lymphoma.