Airway dehiscence following silicone stent implantation for stenosis post lung transplantation, a rare complication.
A. Hanna*a (Dr), A. Crutua (Dr), P. Baldeyroua (Dr), D. Mitilianb (Dr), D. Fabreb (Prof), J. Le Paveca (Dr), E. Fadelb (Prof)
a Interventional bronchoscopy unit, Department of Pulmonary medicine and Lung Transplantation, Marie Lannelongue Hospital., Le Plessis Robinson, FRANCE ; b Department of Thoracic, Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital., Le Plessis Robinson, FRANCE
Here we present a case of a 47 years old female patient, with double-lung transplantation for pulmonary hypertension secondary to scleroderma. She developed 5 months after transplantation multiple airway stenosis. Five sessions of bronchoscopic dilatations were done with successful silicon stent 10x20 mm implantation of the left main bronchus.
At day 11 after stenting, she presented with shortness of breath, tachypnea, fever and was hospitalized in the ICU due to septic shock with respiratory distress syndrome. Blood sample showed: Leucopenia 0.9 g/l, hyponatremia 128mg/L, kalaemia 3.5mmol/L, CRP 522mg/l. Blood gases showed a compensated metabolic acidosis. CT scan showed atelectasis of the left lower lobe with multiple bilateral pulmonary infiltrates. The patient was then intubated and mechanically ventilated. Fluid resuscitation, vasopressors, inotropes together with antimicrobial were instaured.
Fiberoptic bronchoscopy showed perfectly positioned stent in the left main bronchus. BAL was positive for a pseudomonas aeroginosa treated with antimicrobials.
Patient was extubated after sepsis control, then referred to our center for assessment. A new CT scan was done showing multiple bilateral excavated lung nodules and an 18 mm donor’s left main stem diameter. Fiberoptic bronchoscopy showed left main bronchus stent floating in the airway with necrosis of the donor’s bronchus, leading to stent ablation. Bronchial aspiration revealed aspergillus fumigatus and pseudomonas aeruginosa that were treated accordingly. Bronchoscopic surveillance surveillance showed healing stenotic left main bronchus which was then dilated.
Airway stenosis is the most common airway complication following lung transplantation. The management is usually dilatation and stenting. Airway dehiscence after stenting is a rare complication. We attribute dehiscence in this case to the septic shock and the role of vasopressors in reducing airway blood flow at an early stage of the post transplantation period.
Disclosure of funding source(s): none