Bronchiovenous Fistula Causing Bleeding and Air Embolism: an Unusual Complication of Bronchoscopic Tumor Resection

Sigurðsson, Martin I; Sigurdsson, Hjortur; Hreinsson, Kári; Símonardóttir, Líney; Guðbjartsson, Tómas

doi:10.1164/ajrccm.183.5.681b

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Currently, surgical resection is considered the first treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy [6,14]. Of the 6 cases of tracheal MEC we retrieved, 2 cases were due to worsening upper airway obstruction, and emergency rigid bronchoscopy followed by electrocautery snaring was performed to remove the bulk of the tumor [15,16] .…”

Section: Discussionmentioning

confidence: 99%

PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

2022

IJCR

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Background: Tracheal mucoepidermoid carcinoma is a rare form of non-small cell lung carcinoma and is defined as a tumor characterized by a combination of squamous, mucus-secreting, and intermediate cell types. This carcinoma is usually located in the lobar or segmental bronchus. Currently, surgery is the preferred treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy. Case presentation: A 50-year-old Chinese male presented with cough, shortness of breath and hemoptysis, and the effect of antibiotic therapy was not good. Subsequently, the airway occupied lesion was found by chest CT, and he was transferred to our hospital for surgical resection. Histologically, the tumor contained squamous epidermal cells, mucoepidermoid cells and intermediate cells. Immunohistochemistrically, the tumor cells were positive for p63, CK5/6, CK7 and Ki67. However, the tumor is generally negative for TTF-1 and neuroendocrine markers. The patient had no recurrence 15 months after the surgery. Conclusions: We report a rare case of mucoepidermoid carcinoma in the distal trachea in which the surgery was difficult and could not be performed like a traditional pulmonary resection. We first provide a comprehensive description of airway management and anesthesia intubation. After surgery, we reviewed the literature and found that PD-1/PD-L1 detection had never been reported in tracheal mucoepidermoid carcinoma. Therefore, we studied the PD-1/PD-L1 pathway in this patient, and the results were negative, which may indicate that potential adjuvant therapy with immune checkpoint inhibitors (ICIs) is not useful in this case.

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Section: Discussionmentioning

confidence: 99%

PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

2022

IJCR

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“…Currently, surgical resection is considered the rst treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy [6,14]. Of the 6 cases of tracheal MEC we retrieved, 2 cases were due to worsening upper airway obstruction, and emergency rigid bronchoscopy followed by electrocautery snaring was performed to remove the bulk of the tumor [15,16]. One patient injured the azygous vein and a branch from the right pulmonary artery leading to massive intratracheal bleeding, and an emergency sternotomy was performed.…”

Section: Discussionmentioning

confidence: 99%

PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

Liu

Guo

et al. 2021

Preprint

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Background: Tracheal mucoepidermoid carcinoma is a rare form of non-small cell lung carcinoma and is defined as a tumor characterized by a combination of squamous, mucus-secreting, and intermediate cell types. This carcinoma is usually located in the lobar or segmental bronchus. Currently, surgery is the preferred treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy. Case presentation: A 50-year-old Chinese male presented with cough, shortness of breath and hemoptysis, and the effect of antibiotic therapy was not good. Subsequently, the airway occupied lesion was found by chest CT, and he was transferred to our hospital for surgical resection. Histologically, the tumor contained squamous epidermal cells, mucoepidermoid cells and intermediate cells. Immunohistochemistrically, the tumor cells were positive for p63, CK5/6, CK7 and Ki67. However, the tumor is generally negative for TTF-1 and neuroendocrine markers. The patient had no recurrence 15 months after the surgery.Conclusions: We report a rare case of mucoepidermoid carcinoma in the distal trachea in which the surgery was difficult and could not be performed like a traditional pulmonary resection. We first provide a comprehensive description of airway management and anesthesia intubation. After surgery, we reviewed the literature and found that PD-1/PD-L1 detection had never been reported in tracheal mucoepidermoid carcinoma. Therefore, we studied the PD-1/PD-L1 pathway in this patient, and the results were negative, which may indicate that potential adjuvant therapy with immune checkpoint inhibitors (ICIs) is not useful in this case.

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“…A broncho-vascular fistula can form due to inflammation or heat coagulation and mechanical destruction of the tumour and adjacent tissue [7,10]. In this case, electrocautery ablation of the tumour accompanied by mechanical debridement of the bronchus might have resulted in the formation of the broncho-vascular fistula [1,11]. Gas can enter the circulation through the fistula, and a gas embolism can easily enter a bronchovascular fistula if the internal airway pressure goes up with the bronchoscopy process or when the patient is accepting positive pressure ventilation, coughing or taking a deep breath during the procedure [7,[12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Cerebral arterial air embolism after endobronchial electrocautery: a case report and review of the literature

Liu

Gao

et al. 2021

BMC Pulm Med

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Background Endobronchial electrocautery is a common and safe therapeutic endoscopic treatment for malignant airway obstruction. Cerebral arterial air embolism (CAAE) is a rare but potentially fatal complication of endobronchial electrocautery. Case presentation We present the first case of cerebral arterial air embolism after endobronchial electrocautery. A 56-year-old male with a pulmonary tumour in the right upper lobe received repeated endobronchial electrocautery. During the procedure, he experienced unresponsiveness, hypoxemia and bradycardia, and he developed tetraplegia. Brain computed tomography showed several cerebral arterial air emboli with low-density spots in the right frontal lobe. He received hyperbaric oxygen therapy with almost full recovery, except for residual left-sided weakness. Conclusions General physicians should realize that CAAE may be a possible complication of endobronchial electrocautery. Several measures, including avoiding positive pressure, lowering ventilatory pressures if possible, avoiding advancing the bronchoscope to occlude the bronchus and using the non-contact technique, should be used to prevent this devastating complication.

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Bronchiovenous Fistula Causing Bleeding and Air Embolism: an Unusual Complication of Bronchoscopic Tumor Resection

Cited by 6 publications

References 5 publications

PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

Cerebral arterial air embolism after endobronchial electrocautery: a case report and review of the literature

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