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Endobronchial stent insertion to manage hemoptysis caused by lung cancer.

Chung IH, Park MH, Kim DH, Jeon GS - J. Korean Med. Sci. (2010)

Bottom Line: However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition.We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent.The patient could be extubated and was able to undergo further palliative therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
Hemoptysis in patients with lung cancer is not uncommon and sometimes have dangerous consequences. Hemoptysis has been managed with various treatment options other than surgery and medicine, such as endobronchial tamponade, transcatheter arterial embolization and radiation therapy. However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition. We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent. The patient could be extubated and was able to undergo further palliative therapy. No recurrent episodes of hemoptysis occurred for the following three months. As our case, airway stenting is a considerable option for the tamponade of a bleeding lesion that cannot be successfully managed with other treatment methods and could be used to preserve airway patency in a select group of patients.

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Related in: MedlinePlus

A bronchial stent was placed in the left main bronchus. (A) A fluoroscopic image shows the bronchial stent and a totally collapsed left lung. (B) Bronchoscopy performed just after the bronchial stent placement shows the proximal end of the stent, which was exactly positioned at the orifice of the left main bronchus.
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Figure 1: A bronchial stent was placed in the left main bronchus. (A) A fluoroscopic image shows the bronchial stent and a totally collapsed left lung. (B) Bronchoscopy performed just after the bronchial stent placement shows the proximal end of the stent, which was exactly positioned at the orifice of the left main bronchus.

Mentions: 49-yr-old male visited our hospital because of dysphasia, hoa-rseness and a 10 kg weight loss experienced over the previous three months. Approximately five months prior to this visit, the patient was diagnosed with a central lung mass in the left hilar area based on a chest radiograph obtained during a health check. However, the patient refused further evaluation at the time. We performed computed tomography (CT) imaging, which revealed a huge central lung mass obstructing the left main bronchus and the proximal portion of the left upper and lower lobar bronchi. This mass invaded the carina, adjacent esophagus and left main pulmonary artery surrounding the descending thoracic aorta. A bronchoscopic biopsy was performed and the mass was finally confirmed as non-small cell lung cancer, specifically a squamous cell carcinoma. After a 12 cm covered esophageal stent was inserted to relieve dysphagia, chemotherapy was started. About one month later, the patient revisited the emergency department with sudden aggravation of dyspnea and coughing. Respiration rates were initially 36/min and increased to 44/min for one hour after hospitalization. The patient was intubated for mechanical ventilator support and was managed in the intensive care unit. Blood-tinged sputum developed during the first day of admission. Three days after admission, a chest radiography showed the left lung had totally collapsed and bloody secretions were aggravated with no evidence of coagulopathy. The hemoglobin level had dropped from 10.7 g/dL to 8.8 g/dL during the course of one day. At this time, a bronchoscopic examination demonstrated the presence of an endoluminal protruding mass with extrinsic compression from the distal trachea to the left main bronchus. The orifice of the left main bronchus was completely obstructed by the mass and was coated by bloody and fibrinous clots. There was diffuse bleeding from the mucosal surface of the mass without a localized focus. Epinephrine was sprayed on the area to control the bleeding. However, this was only temporarily effective and bleeding continued intermittently. From the eighth day after admission, blood was aspirated through endotracheal tube continuously. Bronchial artery embolization could not be considered as an option to control the bleeding, because it was not active arterial bleeding and there was no prominent contrast enhancement of the mass as seen on a CT scan. Surgical resection also could not be considered because of the advanced stage of the cancer. On the tenth day after admission, a bronchial stent was inserted to achieve a tamponade effect to stop the bleeding and to maintain luminal patency of the left main bronchus. A hydrophilic guidewire (Radiofocus: Terumo, Tokyo, Japan) was inserted under bronchoscopic guidance and an angiographic catheter (Angled Taper; Terumo, Tokyo, Japan) was then advanced into the lower lobar bronchus. A small amount of non-ionic contrast material was injected into the airway to identify the bronchial tree, as we were unable to discriminate the airway on a fluoroscopic image due to the total collapse of the left lung. A stiff guidewire (Amplatz Super Stiff; Boston Scientific, Watertown, MA, USA) was inserted into the left lower lobar bronchus and a 12 mm-6 cm self-expanding polytetrafluoroethylene (PTFE)-covered nitinol stent (Taewoong Medical, Seoul, Korea) was deployed in the left main bronchus under fluoroscopic guidance (Fig. 1). Blood in the endotracheal tube decreased markedly and dyspnea was relieved soon after bronchial stent placement. Two days after the stent placement, the patient was extubated and blood-tinged sputum had disappeared completely four days later (Fig. 2). Radiation therapy was started eleven days after stent placement. During radiation therapy, a total collapse of the left lung again developed. A mass in the proximal left main bronchus that was not covered by the stent was removed by bronchoscopy and left lung aeration improved. The patient expired three months after stent placement due to disease progression. During this period, there was no frank hemoptysis, except for several episodes of blood-tinged sputum.


Endobronchial stent insertion to manage hemoptysis caused by lung cancer.

Chung IH, Park MH, Kim DH, Jeon GS - J. Korean Med. Sci. (2010)

A bronchial stent was placed in the left main bronchus. (A) A fluoroscopic image shows the bronchial stent and a totally collapsed left lung. (B) Bronchoscopy performed just after the bronchial stent placement shows the proximal end of the stent, which was exactly positioned at the orifice of the left main bronchus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908804&req=5

Figure 1: A bronchial stent was placed in the left main bronchus. (A) A fluoroscopic image shows the bronchial stent and a totally collapsed left lung. (B) Bronchoscopy performed just after the bronchial stent placement shows the proximal end of the stent, which was exactly positioned at the orifice of the left main bronchus.
Mentions: 49-yr-old male visited our hospital because of dysphasia, hoa-rseness and a 10 kg weight loss experienced over the previous three months. Approximately five months prior to this visit, the patient was diagnosed with a central lung mass in the left hilar area based on a chest radiograph obtained during a health check. However, the patient refused further evaluation at the time. We performed computed tomography (CT) imaging, which revealed a huge central lung mass obstructing the left main bronchus and the proximal portion of the left upper and lower lobar bronchi. This mass invaded the carina, adjacent esophagus and left main pulmonary artery surrounding the descending thoracic aorta. A bronchoscopic biopsy was performed and the mass was finally confirmed as non-small cell lung cancer, specifically a squamous cell carcinoma. After a 12 cm covered esophageal stent was inserted to relieve dysphagia, chemotherapy was started. About one month later, the patient revisited the emergency department with sudden aggravation of dyspnea and coughing. Respiration rates were initially 36/min and increased to 44/min for one hour after hospitalization. The patient was intubated for mechanical ventilator support and was managed in the intensive care unit. Blood-tinged sputum developed during the first day of admission. Three days after admission, a chest radiography showed the left lung had totally collapsed and bloody secretions were aggravated with no evidence of coagulopathy. The hemoglobin level had dropped from 10.7 g/dL to 8.8 g/dL during the course of one day. At this time, a bronchoscopic examination demonstrated the presence of an endoluminal protruding mass with extrinsic compression from the distal trachea to the left main bronchus. The orifice of the left main bronchus was completely obstructed by the mass and was coated by bloody and fibrinous clots. There was diffuse bleeding from the mucosal surface of the mass without a localized focus. Epinephrine was sprayed on the area to control the bleeding. However, this was only temporarily effective and bleeding continued intermittently. From the eighth day after admission, blood was aspirated through endotracheal tube continuously. Bronchial artery embolization could not be considered as an option to control the bleeding, because it was not active arterial bleeding and there was no prominent contrast enhancement of the mass as seen on a CT scan. Surgical resection also could not be considered because of the advanced stage of the cancer. On the tenth day after admission, a bronchial stent was inserted to achieve a tamponade effect to stop the bleeding and to maintain luminal patency of the left main bronchus. A hydrophilic guidewire (Radiofocus: Terumo, Tokyo, Japan) was inserted under bronchoscopic guidance and an angiographic catheter (Angled Taper; Terumo, Tokyo, Japan) was then advanced into the lower lobar bronchus. A small amount of non-ionic contrast material was injected into the airway to identify the bronchial tree, as we were unable to discriminate the airway on a fluoroscopic image due to the total collapse of the left lung. A stiff guidewire (Amplatz Super Stiff; Boston Scientific, Watertown, MA, USA) was inserted into the left lower lobar bronchus and a 12 mm-6 cm self-expanding polytetrafluoroethylene (PTFE)-covered nitinol stent (Taewoong Medical, Seoul, Korea) was deployed in the left main bronchus under fluoroscopic guidance (Fig. 1). Blood in the endotracheal tube decreased markedly and dyspnea was relieved soon after bronchial stent placement. Two days after the stent placement, the patient was extubated and blood-tinged sputum had disappeared completely four days later (Fig. 2). Radiation therapy was started eleven days after stent placement. During radiation therapy, a total collapse of the left lung again developed. A mass in the proximal left main bronchus that was not covered by the stent was removed by bronchoscopy and left lung aeration improved. The patient expired three months after stent placement due to disease progression. During this period, there was no frank hemoptysis, except for several episodes of blood-tinged sputum.

Bottom Line: However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition.We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent.The patient could be extubated and was able to undergo further palliative therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
Hemoptysis in patients with lung cancer is not uncommon and sometimes have dangerous consequences. Hemoptysis has been managed with various treatment options other than surgery and medicine, such as endobronchial tamponade, transcatheter arterial embolization and radiation therapy. However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition. We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent. The patient could be extubated and was able to undergo further palliative therapy. No recurrent episodes of hemoptysis occurred for the following three months. As our case, airway stenting is a considerable option for the tamponade of a bleeding lesion that cannot be successfully managed with other treatment methods and could be used to preserve airway patency in a select group of patients.

Show MeSH
Related in: MedlinePlus