title: It's better to be lucky … successful management of an acute endobronchial tumour embolism in the ICU: a case report and review of the literature.
abstract: Endobronchial tumour embolism is a rare cause of acute central airway obstruction. It is primarily reported during pneumonectomy, and the outcome is frequently fatal. Successful management requires the urgent removal of tumour with rigid or flexible bronchoscopy. We present the case of a 62-year-old woman with poorly differentiated non-small cell lung cancer (NSCLC), referred to our institution for Nd:YAG laser photoresection of endobronchial tumour completely obstructing the right mainstem bronchus (RMSB). Soon after admission, our patient developed critical hypoxemia, rapidly followed by cardiac arrest. Bronchoscopy was urgently performed and revealed a necrotic tumour occluding the left mainstem bronchus (LMSB), with some residual tumour and clot at the RMSB. The tumour acutely obstructing the LMSB was successfully extracted using a foreign body retrieval basket and large flexible biopsy forceps via a large (therapeutic) flexible bronchoscope. Ventilation immediately improved, with the return of a pulse, and the patient was successfully extubated the next day. Pathology of the tumour embolism revealed NSCLC with necrosis and an adherent clot. Here, we review 16 published reports of endobronchial tumour embolism in relation to our case.
authors.affiliation: Department of Medicine Institute of Medical Sciences, Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto Toronto Canada.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Walsh
authors.affiliation: Department of Respirology Montreal Chest Institute, McGill University Health Centre Montreal Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Olivenstein
authors.affiliation: Department of Respirology Hôpital de Hull Gatineau Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Forget
authors.affiliation: Department of Respirology Montreal Chest Institute, McGill University Health Centre Montreal Canada; Respiratory Epidemiology and Clinical Research Unit McGill University Montreal Canada.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Gonzalez
keywords: Airway obstruction; intensive care medicine; interventional pulmonology; lung cancer; thoracic surgery