Tracheal Rhinosporidiosis: A Report of a Rare Case From Odisha, India

TL;DR

A rare case of tracheal rhinosporidiosis was successfully treated using a multidisciplinary surgical approach involving cardiopulmonary bypass.

Contribution

This case report presents an unconventional surgical management of a rare tracheal rhinosporidiosis with multi-site involvement.

Findings

The rhinosporidiosis mass was successfully removed using peripheral cardiopulmonary bypass and an open surgical approach.

Histopathological analysis confirmed the presence of Rhinosporidium seeberi sporangia with endospores.

The patient recovered uneventfully after surgery with no complications.

Abstract

We report a very rare case of tracheal rhinosporidiosis having multiple sites of involvement in the tracheal lumen, almost completely obstructing the lumen near the carina, which was removed by using peripheral cardiopulmonary bypass (CPB) with a multidisciplinary team approach involving the ENT and cardiothoracic vascular surgery (CTVS) departments.

Since the location of the mass was in the lower trachea and there was a higher risk of bleeding, CPB was done. An open approach was considered for the surgery. A U-shaped neck incision was given, and the trachea was opened at the level of the third, fourth, and fifth tracheal rings. A Hopkins 0° 3 mm 14 cm endoscope was used to visualize the mass, which almost occupied the whole lumen of the trachea near the carina. A rhinosporidiosis mass was found to be attached to the anterolateral aspect of the trachea. The stump of the mass was cauterized by bipolar suction cautery and coblator, and the mass was delivered. The trachea was closed with a cuffed tracheostomy tube (7.5 mm inner diameter (ID)) in situ. After confirming satisfactory ventilation, the patient was weaned off CPB. The duration of CBP was 120 minutes, and the duration of surgery was 80 minutes. The patient was kept in the ICU for 24 hours after surgery. The tracheostomy tube was removed on the fifth post-op day. The patient had an uneventful recovery. The histopathological study of the resected specimen showed sporangia filled with small, round endospores of Rhinosporidium seeberi. We report a rare case of rhinosporidiosis that had to be managed in an unconventional method due to the site and size of the pathology, and to minimize the risk to the patient.

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