Broncho-vascular fistulas from self-expanding metallic stents: A retrospective case review
A 50-year-old male, underwent double lung transplant for idiopathic pulmonary fibrosis (IPF). Two weeks following his transplant, he was readmitted with acute onset of severe shortness of breath. His Computed tomography (CT) of the chest revealed a small air collection adjacent to right anastomotic site with bilateral pleural effusions. His echocardiogram demonstrated large circumferential pericardial effusion with tamponade physiology. The pericardial fluid was evacuated by a pericardial window and a right sided chest tube.\nFlexible bronchoscopy (FB) was performed the same day, which confirmed bilateral bronchial dehiscence, worse on the right, with a 1.5 cm defect of antero-lateral wall of right main stem bronchus with separation of suture line from donor bronchus []. There was a free moving flap and full thickness necrosis of the wall which extended down to bronchus intermedius. A 14 mm × 40 mm uncovered Ultraflex® SEMS was deployed over a guidewire in the right main bronchus to bridge the dehiscence. With bronchoscopic forceps, the stent was gently repositioned firmly against the secondary carina in an effort to cover the defect. A 12 mm controlled radial expansion (CRE) balloon was used to dilate the stent across the area of the anastomosis. The balloon of smaller diameter was used to avoid undue high atmospheric pressures at the site of disruption. At the end of the procedure, the stent was in a visibly good position.\nPatient was doing well at home for 3 weeks when he experienced a sudden massive hemoptysis. In emergency, his airway was noted to be filled with blood and he had right sided hydropneumothorax. He died shortly after arrival in the emergency department. Considering his recent intervention and stent placement, we concurred that BVF was the most likely mechanism of his massive hemoptysis. Unfortunately, family refused an autopsy.