Broncho-vascular fistulas from self-expanding metallic stents: A retrospective case review
A 65-year-old female, diagnosed with non-small cell lung cancer developed respiratory distress and hypoxia requiring a bronchoscopy. It revealed tracheal narrowing due to extrinsic compression from the tumor, in addition to complete occlusion of the left main bronchus due to endobronchial invasion. Extensive tumor debulking was performed using Nd-YAG laser and balloon bronchoplasty. A covered Ultraflex® SEMS 18 mm × 60 mm was placed into distal trachea extending into the left main bronchus. Patient completed her radiotherapy and chemotherapy course. Seven months post intervention patient, she started complaining of increasing wheeze and halitosis. Repeat bronchoscopy revealed tumor ingrowths into the stent, broken stent wires, and a tracheo-mediastinal fistula noted at distal end of the stent. Laser photoresection was done to maintain stent patency. A week later she developed hemoptysis and CT of the chest revealed pneumo-mediastinum from tracheo-mediastinal fistula with irregular medial contour of the aortic arch consistent with invasion of the aorta [] requiring transition to hospice care.