SESSION TITLE: Bronchology/Interventional Procedures Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PM
INTRODUCTION: Kyphoscoliosis causes restrictive pulmonary physiology and when extreme can compress central airways leading to severe respiratory compromise. Definitive therapy is corrective spine surgery.  Patients with severe scoliosis are at high risk for perioperative pulmonary complications.
CASE PRESENTATION: The patient was a 55 year-old female with idiopathic scoliosis, who presented with dyspnea for 4 years with intermittent exacerbations and pneumonia. For 5 months her symptoms were more severe, persistent and severely limited her activity. Pulmonary function tests revealed moderate restriction. Chest computed tomography (CT) demonstrated 100% extrinsic right bronchus intermedius (RBI) compression by an adjacent vertebral body with partial collapse of the right middle (RML) and complete collapse of the right lower lobe (RLL). Radiographically, the RBI compression was persistent for 6 years. The atelectasis of RML and RLL findings were intermittent for 6 years and clinically persistent for 5 months. Bronchoscopy revealed 100% extrinsic RBI compression. She failed chest physiotherapy. Her surgeon deemed her too high risk to operate. Furthermore, given the duration and severity of the RBI compression and RLL collapse, it was not clear spinal surgery would improve her respiratory symptoms or function. Merit Endotek Aero self-expanding metal stents (SEMS) were placed in the RBI, RLL and RML with significant symptomatic and radiographic improvement. She underwent corrective spinal surgery and the SEMS were removed 7 days later. Chest CT at 6 months revealed a partially compressed but patent RBI and fully expanded RML and RLL. (figure 1)
DISCUSSION: Extrinsic compression of central airways by Kyphoscoliosis has been well described and definitive treatment is surgical correction. Our patient was considered too high risk for surgery and her RBI compression of 6 years and lobar collapse greater than 8 weeks were thought perhaps unsalvageable. We describe what we believe to be the first successful report of removable SEMS as a bridge to corrective spinal surgery for severe kyphoscoliosis.
CONCLUSIONS: Retrievable SEMS as a bridge to surgery is a viable option for Kyphoscoliosis-associated central airway compression. Non-malignant long-term central airway compression and lobar atelectasis are not necessarily unsalvageable conditions.
Reference #1: Al-Kattan K, et al: Kyphoscoliosis and bronchial torsion. Chest 1997, 111:1134-1137.
DISCLOSURE: The following authors have nothing to disclose: Narin Sriratanaviriyakul, Lam Phuong Nguyen, Rolando Roberto, Heba Ismail, Ken Yoneda
No Product/Research Disclosure Information