Broncho-vascular fistulas from self-expanding metallic stents: A retrospective case review
A 49-year-old man underwent double lung transplant for Idiopathic Pulmonary Fibrosis and pulmonary hypertension. 10 months following the transplantation he developed breathlessness and wheezing. Bronchoscopy revealed a near total obstruction of the right main bronchus by a whitish, exophytic lesion, which was excised and airway was dilated. Biopsy of the endobronchial lesion revealed an aspergilloma. The patient was appropriately treated with systemic and topical antifungals. Subsequently, he underwent Ultraflex® SEMS placement and brachytherapy (dose - 7.1 Gy × 2) in the right bronchus for excess granulation tissue. He improved initially but two months later developed worsening hemoptysis. While hospitalized, he developed cardiac arrest following massive hemoptysis and required an urgent right pneumonectomy. Decision to perform pneumonectomy was based on clinical suspicion of BVF, a diagnosis compatible with his presentation. Intraoperatively, 1 cm defect in posterior right pulmonary artery was noted, communicating with the SEMS in the right bronchus intermedius. Stent could be grasped from the pulmonary artery but unfortunately he expired the next day.