A novel endobronchial approach to massive hemoptysis complicating silicone Y-stent placement for tracheobronchomalacia: A case report.

Abstract

RATIONALE:

Airway stabilization for severe, symptomatic tracheobronchomalacia (TBM) may be accomplished by silicone Y-stent placement. Common complications of the Y-stent include mucus plugging and granulation tissue formation.

PATIENT CONCERNS:

We describe a rare case of massive hemoptysis originating from a silicone Y-stent placed for TBM.

DIAGNOSES:

An emergent bronchoscopy showed an actively bleeding, pulsatile vessel at the distal end of the left bronchial limb of the Y-stent. It was felt that the bleeding was caused by, or at least impacted by, the distal left bronchial limb of the Y-stent eroding into the airway wall.

INTERVENTIONS:

We hypothesized that placement of oxidized regenerated cellulose (ORC) would provide initial hemostasis, and the subsequent placement of a biocompatible surgical sealant would lead to definitive resolution.

OUTCOMES:

ORC provided sufficient hemostasis and the subsequent synthetic polymer reinforced the tissue for complete cessation of the bleed.

LESSONS:

The combined use of ORC and a biocompatible surgical sealant provided long-term management for life-threatening hemoptysis, and potentially morbid procedures such as embolization or surgery were avoided by advanced endobronchial therapy.

• Authors: Changwan Ryu, Daniel Boffa, Kyle Bramley, Margaret Pisani, Jonathan Puchalski
• Journal: Medicine (Medicine (Baltimore)) Vol. 97 Issue 8 Pg. e9980 (Feb 2018) ISSN: 1536-5964 [Electronic] United States
• PMID: 29465600 (Publication Type: Case Reports, Journal Article)

Chemical References

• Cellulose, Oxidized
• Hemostatics
• Silicones

Topics

• Aged
• Bronchoscopy (methods)
• Cellulose, Oxidized (administration & dosage)
• Female
• Hemoptysis (etiology, surgery)
• Hemostasis, Endoscopic (methods)
• Hemostatics (administration & dosage)
• Humans
• Prosthesis Implantation (instrumentation, methods)
• Silicones
• Stents (adverse effects)
• Tracheobronchomalacia (complications, surgery)