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Serious Complications after Self-expandable Metallic Stent Insertion in a Patient with Malignant Lymphoma.

Cho SB, Cha SA, Choi JY, Lee JM, Kang HH, Moon HS, Kim SW, Yeo CD, Lee SH - Tuberc Respir Dis (Seoul) (2015)

Bottom Line: She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL).The left main bronchus was completely occluded by granulation tissue.However, the right main bronchus and intermedius bronchus were patent.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.

No MeSH data available.


Related in: MedlinePlus

Initial chest radiography shows atelectasis of left lower lung field and metallic stents are placed at both main bronchus (arrows).
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Figure 1: Initial chest radiography shows atelectasis of left lower lung field and metallic stents are placed at both main bronchus (arrows).

Mentions: On initial examination, the blood pressure was 120/70 mm Hg, heart rate 80 beats per minute, respiratory rate 29 breaths per minute, and body temperature was 36.5℃. The lung sounds were decreased, and wheezing was auscultated at the left lower lung; thoracic radiography showed atelectasis in the left lower lung field (Figure 1). A chest computed tomography revealed obstruction in the left main bronchus and left lower lobe collapse (Figure 2A).


Serious Complications after Self-expandable Metallic Stent Insertion in a Patient with Malignant Lymphoma.

Cho SB, Cha SA, Choi JY, Lee JM, Kang HH, Moon HS, Kim SW, Yeo CD, Lee SH - Tuberc Respir Dis (Seoul) (2015)

Initial chest radiography shows atelectasis of left lower lung field and metallic stents are placed at both main bronchus (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4311033&req=5

Figure 1: Initial chest radiography shows atelectasis of left lower lung field and metallic stents are placed at both main bronchus (arrows).
Mentions: On initial examination, the blood pressure was 120/70 mm Hg, heart rate 80 beats per minute, respiratory rate 29 breaths per minute, and body temperature was 36.5℃. The lung sounds were decreased, and wheezing was auscultated at the left lower lung; thoracic radiography showed atelectasis in the left lower lung field (Figure 1). A chest computed tomography revealed obstruction in the left main bronchus and left lower lobe collapse (Figure 2A).

Bottom Line: She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL).The left main bronchus was completely occluded by granulation tissue.However, the right main bronchus and intermedius bronchus were patent.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.

No MeSH data available.


Related in: MedlinePlus