Broncho-vascular fistulas from self-expanding metallic stents: A retrospective case review
A 73-year-old female, ex-smoker with 4 pack-year of smoking history was diagnosed with ovarian adenocarcinoma at 67 years of age. She underwent surgery for local spread of tumor in addition to chemotherapy. Five years following the initial diagnosis she developed a lung lesion and supraclavicular lymphadenopathy. Biopsy from both lesions revealed adenocarcinoma. She received chemotherapy along with external beam radiation. She presented with recalcitrant cough and left lower lobe collapse due to stenosis of the left main stem bronchus from extrinsic compression. A covered 12 mm × 40 mm Ultraflex® SEMS was placed in the left main stem endobronchial lesion with symptomatic and radiographic improvement. Four months following the procedure, the patients developed recurrence of her cough; FB revealed ingrowths of granulation tissue involving the distant third of the stent and an ulcer in lower third of trachea. Bronchial brush cytology was negative for malignant cells. She underwent two separate endobronchial multimodality treatment for debulking of the granulation tissue using electrosurgery, cryoablation, balloon bronchoplasty, and intrabronchial steroid injection. She started experiencing hemoptysis 4 months after her last procedure and a year after initial stent placement. Bronchoscopy revealed blood oozing from stent site in left main stem bronchus. Her CT of chest with contrast showed loss of the tissue plane between the stent and the left pulmonary artery with metallic stent eroding into the left pulmonary artery [Figures and ]. She continued to have recurrent hemoptysis for next 1 year and eventually passed away from exsanguination.