Allergy and Airway |

Cryoextraction for Removal of Obstructive Endobronchial Blood Clots: A Case Report FREE TO VIEW

Himanshu Bhardwaj, MD; Bhaskar Bhardwaj, MBBS; Ahmed Awab, MD; Houssein Youness, MD
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University of Oklahoma Health Sciences Center, Oklahoma City, OK

Chest. 2013;144(4_MeetingAbstracts):7A. doi:10.1378/chest.1699520
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SESSION TITLE: Airway Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchoscopic cryoextraction using a cryoprobe is a lesser studied therapeutic modality which can be used to remove foreign bodies, especially those containing sufficient water or freezable liquid from the lower airways. Acute symptomatic airway obstruction due to blood clots can develop as complication from various pulmonary procedures.

CASE PRESENTATION: A 54 years old male with history of renal transplant, on chronic immunosuppressant therapy was admitted to the intensive care unit with right lower lobe pneumonia (Figure 1 Panel A ) requiring endotracheal intubation due to hypoxic respiratory failure. Due to history of chronic immunosuppressive therapy a bronchoalveolar lavage (BAL) was attempted for targeted antimicrobial therapy. Bronchoscopic exam of the airways showed friable endobronchial mucosa with thick purulent secretions. Unfortunately a massive endobronchial bleed due to iatrogenic mucosal tear complicated the procedure. Patient became extremely hypoxic despite 100% FIO2. Urgent chest radiograph showed worse right lower lobe infiltrates and atelectasis (Figure 1 Panel B). A repeat bronchoscopic exam showed massive blood clot occluding the right main stem bronchus. Removal of blood clot was felt to be necessary to improve oxygenation; this was not achievable with bronchoscopic suction. A cryoprobe was inserted through the bronchoscope into the airways and was applied to the clot and frozen. Clot got firmly attached to the probe and was successfully pulled out in large piece (Figure 2). This resulted in immediate improvement in patient’s oxygenation.

DISCUSSION: Bronchial mucosal damage from infections, tumors, suction catheter manipulation during flexible bronchoscopy can result in endobronchial bleeding. On occasions this can lead to large airway clot formation causing acute airway obstruction and ultimately resulting in significant hypoxia. Different instruments used in foreign body removal (grasping forceps, balloon catheters, baskets, snares, magnets and so on) are usually ineffective due to friable structure of the clot. Suctioning of the blood clot with flexible bronchoscope is not always successful and could pose a risk of rebleeding. Cryoextraction allows freezing of the blood clots leading to their adhesion to the probe and thus successful removal.

CONCLUSIONS: Cryoextraction is a safe and effective modality in the removal of large endobronchial blood clots causing symptomatic obstruction. In addition to the immediate effect and it has a short learning curve, the procedure has few complications and is cost-effective.

Reference #1: 1.Weerdt S, Noppen M, Remels L, et al. Successful removal of a massive endobronchial clot by means of cryotherapy. Journal of Bronchology. 2005; 12:23-24.

Reference #2: 2.Franke KJ, Nilius G, Rühle KH. Use of cryoextraction in different types of airway obstruction. Pneumologie. 2010; 64:387-9.

DISCLOSURE: The following authors have nothing to disclose: Himanshu Bhardwaj, Bhaskar Bhardwaj, Ahmed Awab, HOussein Youness

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