Use of the flow-volume loop in the diagnosis of bronchial stenosis after single lung transplantation.
Bronchial complications, including stricture, stenosis, and/or anastomotic dehiscence, are a major cause of morbidity following single lung transplantation. This report describes a 19-year-old man with a diagnosis of end-stage pulmonary fibrosis secondary to prior chemotherapy for non-Hodgkins lymphoma who underwent single lung transplantation. The immunosuppressive regimen included cyclosporine, azathioprine, and methylprednisolone sodium succinate (Solu-Medrol) intravenously for six doses during the first 3 days postoperatively followed by oral prednisone. Sixteen weeks following transplantation, the patient complained of dyspnea. Spirometry revealed a decrease in FEF25-75 and the flow-volume curve demonstrated a bioconcave appearance. The flow-volume loop showed a relatively high initial flow phase occurring over the first 2 to 3 s followed by a low-flow phase. The expiratory phase also showed the same characteristics. Bronchoscopy revealed 75 percent stenosis of the bronchial lumen to the transplanted lung. A transbronchial biopsy specimen obtained at that time was consistent with acute rejection. The patient was treated with a methylprednisolone bolus. A repeated bronchoscopy showed the persistence of stenosis distal to the anastomosis. The patient underwent several bronchoplastic balloon dilatations without complete resolution of the stenosis and a stainless steel mesh stent was placed. Repeated spirometry showed marked improvement of the FEF25-75 and normalization of the flow-volume loop. We conclude that the flow-volume loop curve is a noninvasive procedure that may help monitor the patency of the bronchial anastomoses following single lung transplantation.
Anzueto
A
A
Department of Medicine (Division of Pulmonary Diseases), University of Texas Health Science Center at San Antonio.
Levine
S M
SM
Tillis
W P
WP
Calhoon
J H
JH
Bryan
C L
CL
D000328:Adult; D001761:Bleomycin / Q000009:adverse effects; D001982:Bronchial Diseases / Q000175:diagnosis* / Q000628:therapy; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D016040:Lung Transplantation; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008449:Maximal Expiratory Flow-Volume Curves; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D011658:Pulmonary Fibrosis / Q000139:chemically induced / Q000601:surgery; D015607:Stents
D001761:Bleomycin