| Autor: |
Machuzak MS; Pulmonary, Critical Care Medicine and Sleep Consultants, Houston Methodist Hospital, Houston, TX †Pulmonary, Critical Care & Sleep Medicine Consultants, Texas Medical Center, Houston, TX ‡Pulmonary, Allergy & Critical Care Medicine, University of Alabama, Tuscaloosa, AL., Santacruz JF, Jaber W, Gildea TR |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of bronchology & interventional pulmonology [J Bronchology Interv Pulmonol] 2015 Jan; Vol. 22 (1), pp. 85-9. |
| DOI: |
10.1097/LBR.0000000000000099 |
| Abstrakt: |
Tracheal or bronchial-mediastinal fistulas are a rare entity associated to high mortality. We report a case of a 58-year-old man with an unresectable non-small cell carcinoma of the lung, treated with chemoradiation followed by bevacizumab. Approximately, 6 weeks after starting bevacizumab he developed a severe cough with copious secretions He could not lie supine due to the feeling of drowning. Investigations revealed a large tracheo-mediastinal-parenchymal-pleural fistula. Palliative management was offered with interventional bronchoscopic techniques. He was found to have a large central airway defect that obliterated almost 40% of the trachea. Under general anesthesia and positive pressure ventilation, a unique approach was used to rebuild an eroded tracheal and right main stem bronchial wall. A self-expanding metallic stent (SEMS) was placed to provide a scaffold of support, whereas a Dumon Y-stent was placed inside the SEMS. This combination allowed for a patent, stable airway; recreating the normal anatomy in a minimally invasive manner walling off the fistula. The patient was discharged 2 days after the bronchoscopic intervention, with significant palliation of his symptomatology. Eighteen months later, the upper lobe cavity persists with a stable airway and stents perfectly positioned with clinically insignificant evidence of stent related granulation in the upper trachea. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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