BRONCHOSCOPIC INTERVENTION FOR TREATMENT OF RESPIRATORY FAILURE DUE TO ENDOBRONCHIAL TUMOR

Abstract

SESSION TITLE: Lung Cancer 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Airway obstruction from endobronchial tumors is a cause of morbidity and mortality in about 20-30% of lung cancer cases (1). Respiratory failure due to airway obstruction can prevent these patients from receiving standard treatment including chemotherapy, radiation or immunotherapy. Therapeutic bronchoscopy can effectively relieve obstructions in a timely manner with different techniques. CASE PRESENTATION: 56-year-old female who was diagnosed with metastatic lung adenocarcinoma about 10 months ago and received chemotherapy and radiation presented to emergency department with symptoms of progressive dyspnea and palpitations with duration of about two weeks. On presentation she had severe hypoxemia and chest imaging showed whole right lung collapse. A few weeks prior to this presentation patient had good functional status, and was able to walk several blocks. A computerized tomography (CT) scan about 1 month ago showed the known right upper lobe and right hilar mass (3.0 and 4.2 cm in largest diameters respectively) with adequate lung volumes bilaterally. The patient continued to decompensated with respiratory failure and altered mental status. Assessment by Interventional pulmonology found the patient would be a good candidate for endoluminal tumor ablation and stent placement. A flexible bronchoscopy revealed an endobronchial tumor in right main stem bronchus with complete obstruction The endobronchial lesion was partially excised with a snare cautery and cryoablation. The bronchoscope was then passed into the bronchus intermedius and balloon dilatation was performed in right main stem and bronchus intermedius, followed by placement of a 40 by 12 mm tracheobronchial stent with post stent lumen size of 80% of normal. Repeat CT scan showed stent in place, and re-expansion of entire right lung. There was significant improvement in functional status soon after the procedure and she was back to her baseline activities with no need for any oxygen supplementation. She was able to receive her planned chemotherapy thereafter. DISCUSSION: Timely use of ablation techniques and stent placement can be an effective way in maintaining airway patency and improve overall functional status. (2) In review of our patient's eligibility criteria for intervention it was noted her functional status prior to admission was good and the duration of respiratory symptoms was less than 4 weeks. Furthermore, existence of patent airways distal to the obstructed site was evident in prior images which increased the likelihood of re-expansion. Other factors such as lack of other underlying lung disease, pulmonary embolism, pleural effusions or heart failure made bronchoscopic intervention likely to be successful. CONCLUSIONS: Airway obstruction can contribute to high morbidity and mortality rates in patients with lung cancer. Bronchoscopic interventions can be used to treat respiratory failure in carefully selected patients. Reference #1: Ernst, A., Feller-Kopman, D., Becker, H. D., & Mehta, A. C. (2004, June 15). Central airway obstruction. American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.200210-1181SO Reference #2: Theodore, P. R. (2009). Emergent Management of Malignancy-Related Acute Airway Obstruction. Emergency Medicine Clinics of North America. W.B. Saunders. https://doi.org/10.1016/j.emc.2009.01.009 DISCLOSURES: No relevant relationships by Rahul Nair, source=Web Response No relevant relationships by Ali Sadoughi, source=Web Response