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: Massive hemoptysis is defined as bleeding of more than 100ml/hr to greater than 500ml of blood in 24 hours. We present a case of use of endobronchial-stent placement for massive hemoptysis.
CASE PRESENTATION: A 56 y/o gentleman presented with cough. Bronchoscopy showed narrowing of left lower lobe bronchus with obstruction. Balloon dilation, cryotherapy was done to dilate left lower lobe bronchus and a self-expanding stent was placed in left lower lobe bronchus. Biopsy was positive for adenocarcinoma and he was started on chemotherapy and radiation treatment. Patient presented later with massive hemoptysis. Repeat bronchoscopy showed bleeding from left lower lobe bronchus. Endobronchial stent was removed after which patient had massive hemoptysis(1200ml). Patient was placed in left lateral position with continued suctioning of blood from right bronchial tree. Topical epinephrine and thrombin were used in left lower lobe bronchus which did not control bleeding. Endobronchial stent was placed in distal left main bronchus extending into the patent left upper lobe thereby tamponading left lower lobe. There was no more hemoptysis and patient was extubated next day.
DISCUSSION: Massive hemoptysis is a rare life threatening condition. First step is to position the patient in dependent position on the side of bleeding and establishing a secure airway. Balloon tamponade, iced saline lavage, topical medications, laser therapy, electrocautery, argon plasma coagulation or cryotherapy are commonly used to treat massive hemoptysis. Arteriographic embolization can be used to embolise potential bleeding sites. With advent of endobronchial stents, few cases have been reported on use of endobronchial stent in massive hemoptysis. Chung et.al and Brandes et.al reported cases of using endobronchial airway stenting for tamponade of a bleeding lesion secondary to tumor. Endobronchial stent placement may allow early extubation and palliative chemotherapy in these patients. It can cause complications like stent migration, accumulation of secretion, membrane disruption and bleeding on removal.
CONCLUSIONS: Endobronchial stenting is an option for the tamponade of a bleeding area in massive hemoptysis and can be used to protect airway patency in selected patients.
Reference #1: Occlusive endobronchial stent placement as a novel management approach to massive hemoptysis from lung cancer. Brandes. Thorac Oncol. 2008 Sep;3(9)
Reference #2: Endobronchial Stent Insertion to Manage Hemoptysis caused by Lung Cancer. In Hee Chung. J Korean Med Sci. Aug 2010; 25(8)
DISCLOSURE: The following authors have nothing to disclose: Shrinivas Kambali, Menfil Andres Orellana Barrios, Raed Alalawi
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