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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

The covered-self expandable metallic stent is retrieved in fragments.
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Figure 3: The covered-self expandable metallic stent is retrieved in fragments.

Mentions: Flexible bronchoscopy showed an obstruction in the left main bronchus, and the bronchoscope was unable to proceed beyond the bronchus mid portion due to the excessive granulation tissue (Figure 2C). The right main bronchus was relatively patent (Figure 2B), but excessive granulation tissue was noted (Figure 2D). After excising the granulation tissue using a rigid bronchoscope, the covered-SEMS was visualized distally. The implant was overgrown with granulation tissue, and the metallic wires were pressed against the bronchial wall. The implant removed from the left bronchus in fragments using alligator forceps (Figure 3), and once removed, bronchomalacia and excessive granulation was observed in the left main bronchus. There were no complications after removing the covered-SEMS and attached granulation tissue.


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)

The covered-self expandable metallic stent is retrieved in fragments.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: The covered-self expandable metallic stent is retrieved in fragments.
Mentions: Flexible bronchoscopy showed an obstruction in the left main bronchus, and the bronchoscope was unable to proceed beyond the bronchus mid portion due to the excessive granulation tissue (Figure 2C). The right main bronchus was relatively patent (Figure 2B), but excessive granulation tissue was noted (Figure 2D). After excising the granulation tissue using a rigid bronchoscope, the covered-SEMS was visualized distally. The implant was overgrown with granulation tissue, and the metallic wires were pressed against the bronchial wall. The implant removed from the left bronchus in fragments using alligator forceps (Figure 3), and once removed, bronchomalacia and excessive granulation was observed in the left main bronchus. There were no complications after removing the covered-SEMS and attached granulation tissue.

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