Endobronchial-Covered Stent Insertion as a Therapeutic Option in Massive Hemoptysis Caused by Lung Cancer

Abstract

SESSION TITLE: Bronchology Student/Resident Case Report Posters SESSION TYPE: Medical Student/Resident Case Report PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM 02:30 PM INTRODUCTION: Among the myriad clinical presentations of lung cancer, life threatening hemoptysis may be the most difficult to treat. Identification of the site of bleeding within the airways plays a key role in the approach to management, as the location dictates the most efficacious treatment option. The most common treatments include pharmacological, bronchoscopic intervention, vascular embolization and surgical resection. We herein report a novel approach to massive hemoptysis in a patient found to have an actively bleeding carinal mass invading and obstructing the right main bronchus. CASE PRESENTATION: 66-year-old Caucasian female with past medical history of hypertension and smoking presented with massive hemoptysis which was immediately and successfully controlled and airway patency reestablished with the insertion of an endobronchial-covered stent. The mass was identified at bronchoscopy as squamous cell carcinoma and the patient was later referred for radiation therapy. Four weeks later, after receiving a total of 5 sessions of radiotherapy, the patient presented with throat discomfort and odynophagia. Computed tomography scan showed tumor reduction with increased lumen size of the right main bronchus and migration of the stent into the hypopharynx. The stent was successfully removed without incident. No episodes of additional hemoptysis occurred. DISCUSSION: When alternative treatment modalities fail or are precluded by the central location of the bleeding site, covered endobronchial stent placement should be considered an indispensible option in this select group of patients, as it can achieve immediate airway patency as well as tamponade of the bleeding focus. CONCLUSIONS: Complications of endobronchial stent placement including migration and perforation should be identified and treated early. Reference #1: Saad CP, Murthy S, Krizmanich G, Mehta AC. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest. 2003; 124:1993-9. Reference #2: Brandes JC, Schmidt E, Yung R. Occlusive endobronchial stent placement as a novel management approach to massive hemoptysis from lung cancer. J Thorac Oncol. 2008; 3:1071-2 FREE TO VIEW