Pulmonary artery stent for bronchial adenoid cystic carcinoma causing pulmonary artery stenosis

Abstract

A 46-year-old woman presented with a 6-month history of dyspnea and weight loss on a background of previous pneumonectomy for bronchial adenoid cystic carcinoma 14 years beforehand. Several years prior to this presentation, she had developed left vocal cord palsy and a metastatic lesion to the right buttock confirmed at resection. Investigations included CT pulmonary angiography and right heart catheterisation and demonstrated pulmonary artery stenosis suggestive of vascular encasement, severe pulmonary arterial hypertension and pulmonary nodules. Subsequent pulmonary artery stenting markedly improved both pulmonary artery pressures and the patient's symptoms. The diagnosis of pulmonary artery stenosis due to mediastinal infiltration by metastatic bronchial adenoid cystic carcinoma was based on these findings as well as the presence of the pulmonary nodules and the previous mediastinal (recurrent laryngeal nerve) and metastatic complications. This case is the first report of successful pulmonary artery stenting for this rare complication.

Pulmonary Perfusion Using Intrabronchial Capnography in Pulmonary Artery Stenosis

“…Pulmonary artery stenting has been reported in the management of pulmonary artery compression due to other mediastinal malignant tumors [9-11]. However, in this case, pulmonary artery stenting was not necessary since there were no signs of heart failure.…”

Treatment of pulmonary artery pseudoaneurysms and stenosis with balloon‐expandable stents

“…Pulmonary artery hypertension on presentation can also be discordant with the clinical scenario. Smith et al 18 . reported an estimated PASP of 110 mmHg in a 46 year old with a single main PAS experiencing progressive dyspnoea.…”

“…Pulmonary artery hypertension on presentation can also be discordant with the clinical scenario. Smith et al 18 reported an estimated PASP of 110 mmHg in a 46 year old with a single main PAS experiencing progressive dyspnoea. An estimated PASP of 60 mmHg was also described in a similar aged male with bilateral main PAS presenting with obstructive shock.…”

“…Cases of stented malignant PAS have included primary lung and mediastinal malignancies involving single and bilateral vessels. 5,[15][16][17][18] Presentation is related to variable manifestations of right ventricular stress and pulmonary under-perfusion, ranging from worsening fatigue and dyspnoea to obstructive shock and profound hypotension. Dyspnoea arises from dead space ventilation and is best defined on VQ scan.…”