Patients with primary tumors of the trachea may present with upper airway obstruction, hemoptysis, chronic cough or recurrent pneumonia. Stridor may appear on forced respiration and may progress to breathing at rest as well. The most common tumor of the trachea is the squamous cell carcinoma. The second most common tumor is the adenoid cystic carcinoma (cylindroma). About a third of patients with squamous cell carcinoma of the trachea have extensive mediastinal involvement when first seen. Adenoid cystic carcinomas on the other hand usually have not invaded mediastinal structures when first seen. However, these tumors extend greater distances in the trachea wall than is grossly evident. This extension is by submucosal and perineural invasion which is a histologic characteristic of this type of tumor. The trachea is sometimes involved with neoplasms that are metastatic from other sources (e.g., larynx, esophagus, lung or thyroid gland). This is usually by direct extension rather than hematogenous spread. Inflammatory diseases may affect the trachea as well. This may include endotracheal tuberculosis. Strictures were reported following diphtheria as well, but are not seen presently. Sclerosing mediastinitis (e.g., from histoplasmosis) may produce tracheal stenosis as well. Post-intubation damage to the trachea may also occur. High pressure, low volume, cuffed endotracheal tubes were the primary cause of post-intubation damage, however with the new high volumes, low pressure en-dotracheal cuffs, this is a much less frequent finding. Besides the location of the endotracheal cuff, another possible source of stricture may be the stoma where the tracheostomy tube enters into the trachea. Any patient who has symptoms of airway obstruction who has been previously intubated should be considered to have a possible obstruction secondary to intubation injury.

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