Y-Style Silicone Stent for Treatment of Trachea Massive Hemoptysis Supported by Extracorporeal Membrane Oxygenation
This case report details the management of a 70-year-old woman with massive hemoptysis secondary to lung adenosquamous carcinoma, who was treated with a Y-style silicone stent supported by extracorporeal membrane oxygenation (ECMO). The patient’s complex clinical course highlights the challenges of managing severe tracheal bleeding and respiratory failure in the context of advanced malignancy.
The patient had a confirmed diagnosis of lung adenosquamous carcinoma seven months prior to admission. Genetic testing revealed no epidermal growth factor receptor gene mutations or anaplastic lymphoma kinase fusion gene, leading to treatment with gefitinib for three months followed by two courses of programmed death-1 inhibitors. Approximately one month before admission, she developed facial edema, and computed tomography (CT) imaging revealed superior vena cava syndrome. She subsequently underwent gamma knife radiosurgery ten times.
Ten days prior to the current admission, the patient was intubated due to severe chest tightness and difficulty breathing. Despite mechanical ventilation, her blood oxygen levels could not be maintained, necessitating the initiation of ECMO support. Chest digital radiography at this time showed atelectasis. A bronchoscopic examination revealed extensive necrotic tissue and blood clots obstructing the airway. Repeated saline flushing and cryobiopsy were performed to remove large blood clots, including an intact cast of the bronchial tree involving the right lobe, two segmental branches of the upper lobe, and five segmental branches of the lower lobe. The left main bronchial lumen was found to be unobstructed but with mucosal edema, while the right main bronchial lumen was also unobstructed, and the primary tumor site in the upper lobe was not exposed.
Massive hemoptysis is a life-threatening condition that can be managed through various methods, including iced saline, pharmacological agents, laser therapy, argon plasma coagulation, bronchial artery embolization, and surgery. In this case, conventional treatments were ineffective, and the patient also had tracheal collapse. A Y-style silicone stent was placed via rigid bronchoscopy to achieve hemostasis by compressing the bleeding site at the right-side wall of the lower trachea. Approximately 24 hours after stent placement, no further bleeding was observed, and chest digital radiography indicated partial reexpansion of the lung.
Despite the successful placement of the silicone stent, which effectively stopped the tracheal bleeding and opened the airway, the patient developed diffuse alveolar hemorrhage. Her oxygenation could not be maintained without ECMO support. Unfortunately, she died five days later due to complications related to ECMO.
This case underscores the utility of Y-style silicone stents in managing massive hemoptysis, particularly in patients with tracheal collapse. The stent provided immediate hemostasis and airway patency, although the patient’s underlying condition and complications ultimately led to a poor outcome. The use of ECMO in this context highlights the critical role of advanced life support in managing severe respiratory failure, even when other interventions are successful.
The patient’s clinical course also illustrates the complexities of treating advanced lung cancer with multiple comorbidities. The development of superior vena cava syndrome and the need for gamma knife radiosurgery reflect the aggressive nature of her disease. The failure of targeted therapies and immune checkpoint inhibitors to control the cancer progression further emphasizes the challenges in managing such cases.
In conclusion, this case report demonstrates the potential benefits of Y-style silicone stents in controlling massive hemoptysis and maintaining airway patency in critically ill patients. However, it also highlights the limitations of such interventions in the face of advanced disease and severe complications. The integration of ECMO support in this context provides valuable insights into the multidisciplinary approach required to manage complex cases of respiratory failure and life-threatening bleeding.
doi.org/10.1097/CM9.0000000000000198
Was this helpful?
0 / 0