title: Severe acute airway obstruction and respiratory failure with fibrous plug following photodynamic therapy (PDT): indication for early bronchoscopy and debridement.
abstract: BACKGROUND
  PDT is a safe procedure with most post procedural complications reported as minor. We report a case of severe acute stridor and trachea-bronchial airway obstruction with mucosal sloughing and fibrous plugs resulting in respiratory failure within three hours following PDT. To our knowledge this is the first reported case where stridor and acute respiratory failure resulted within hours following PDT treatment.
  
  
  METHODS
  A 65 year old female with previous right pneumonectomy presented with followup bronchoscopy confirming reoccurrence of carcinoma proximal and distal to the anastomosis. A standard photofrin (Porfimer sodium) was administered at 2mg/kg body weight 48 hours prior to her PDT treatment. Three hours following the procedure, patient become acutely stridurous and was subsequently intubated. Bedside bronchoscopy was performed through the endotracheal tube. During the bronchoscopy thick tracheal plugs were retrieved and slough adjacent to the treatment site was noticed which was debrided. Patient underwent 7 bronchoscopies with debridement before she was discharged.
  
  
  CONCLUSIONS
  Airway obstruction (with NSCLA) is an indication as well as complication (with mucosal debris) of PDT. FDA has advised bronchoscopy at 48-72 hours post procedure, however early intervention with bronchoscopy and debridement should be considered to relieve tracheal bronchial airway obstruction and removal of accessory debris and mucosal slough.
authors.affiliation: Interventional Thoracic Surgery Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Khan
authors.affiliation: Interventional Thoracic Surgery Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Pipkin
authors.affiliation: Interventional Thoracic Surgery Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Mozayyan
authors.affiliation: Interventional Thoracic Surgery Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Hwang
authors.affiliation: Interventional Thoracic Surgery Program, Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: Kazuhiro.Yasufuku@uhn.ca.
authors.forename: K
authors.initials: K
authors.lastname: Yasufuku
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods; D003646:Debridement / Q000379:methods; D017323:Dihematoporphyrin Ether / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether