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

Medicine (Baltimore). 2018 Feb;97(8):e9980. doi: 10.1097/MD.0000000000009980.

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.

Publication types

  • Case Reports

MeSH terms

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

Substances

  • Cellulose, Oxidized
  • Hemostatics
  • Silicones