Is transcatheter rescue management of a pulmonary artery bronchial fistula justified?
Endobronchial brachytherapy and interventional bronchology have changed the management of stage 3A (T4N0M0) non-small cell lung carcinoma. We discuss the case of a female patient who developed massive hemoptysis due to a fistula between the left pulmonary artery and stented left main bronchus. Although transcatheter management of the fistula was initially successful, the patient outcome secondary to coronary insult was poor. We present our management dilemma to highlight the need for careful consideration when selecting patients with heavily irradiated chests for endobronchial stenting.
Department of Surgery, State University of New York Upstate Medical University, Syracuse, New York, USA. bhamidic@upstate.edu
C M
CM
Bhamidipati
L J
LJ
Kohman
D001918:Brachytherapy / Q000009:adverse effects*; D001982:Bronchial Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000295:instrumentation; D003251:Constriction, Pathologic; D017809:Fatal Outcome; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D015641:Radiography, Interventional; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*