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Frontiers in Immunology 2023Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by necrotizing inflammation of small- and medium-sized blood...
BACKGROUND
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by necrotizing inflammation of small- and medium-sized blood vessels and the presence of circulating ANCA. Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic ANCA-associated vasculitis, characterized by peripheral eosinophilia, neuropathy, palpable purpuras or petechiae, renal and cardiac involvement, sinusitis, asthma, and transient pulmonary infiltrates. Middle lobe syndrome (MLS) is defined as recurrent or chronic atelectasis of the right middle lobe of the lung, and it is a potential complication of asthma.
CASE PRESENTATION
Herein, we describe a case of MLS in a 51-year-old woman, never-smoker, affected by EGPA, presenting exclusively with leukocytosis and elevated concentrations of acute-phase proteins, without any respiratory symptom, cough, or hemoptysis. Chest computed tomography (CT) imaging documented complete atelectasis of the middle lobe, together with complete obstruction of lobar bronchial branch origin. Fiberoptic bronchoscopy (FOB) revealed complete stenosis of the middle lobar bronchus origin, thus confirming the diagnosis of MLS, along with distal left main bronchus stenosis. Bronchoalveolar lavage (BAL) did not detect any infection. Bronchial biopsies included plasma cells, neutrophil infiltrates, only isolated eosinophils, and no granulomas, providing the hypothesis of vasculitic acute involvement less likely. First-line agents directed towards optimizing pulmonary function (mucolytics, bronchodilators, and antibiotic course) were therefore employed. However, the patient did not respond to conservative treatment; hence, endoscopic management of airway obstruction was performed, with chest CT documenting resolution of middle lobe atelectasis.
CONCLUSION
To the best of our knowledge, this is the first detailed description of MLS in EGPA completely resolved through FOB. Identification of MLS in EGPA appears essential as prognosis, longitudinal management, and treatment options may differ from other pulmonary involvement in AAV patients.
Topics: Female; Humans; Middle Aged; Middle Lobe Syndrome; Antibodies, Antineutrophil Cytoplasmic; Churg-Strauss Syndrome; Constriction, Pathologic; Granulomatosis with Polyangiitis; Leukocyte Disorders; Pulmonary Atelectasis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Asthma
PubMed: 37638004
DOI: 10.3389/fimmu.2023.1222431 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; Paracoccidioidomycosis; Constriction, Pathologic
PubMed: 37792840
DOI: 10.1590/0037-8682-0343-2023 -
American Journal of Respiratory and... Feb 2013
Topics: Airway Obstruction; Bronchial Diseases; Bronchography; Constriction, Pathologic; Female; Humans; Middle Aged; Trachea
PubMed: 23378438
DOI: 10.1164/rccm.201206-1023IM -
Annals of Thoracic and Cardiovascular... 2015
Topics: Bronchi; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Humans; Pneumonectomy; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26211403
DOI: 10.5761/atcs.ed.15-00189 -
Surgery Today Mar 2022Bronchial stenoses are challenging complications after lung transplantation and are associated with high rates of morbidity and mortality. We report a series of patients...
PURPOSE
Bronchial stenoses are challenging complications after lung transplantation and are associated with high rates of morbidity and mortality. We report a series of patients who underwent bronchoplasty or sleeve resection for bronchial stenoses that did not resolve with endoscopic treatment after lung transplantation.
METHODS
Between 1995 and 2020, 497 patients underwent lung transplantation at our Institution. 35 patients (7.0%) experienced bronchial stenoses with a median time from transplantation of 3 months. Endoscopic management was effective in 28 cases (5.6%) while 1 patient required re-transplantation. Six patients (1.2%) underwent bronchoplasty or sleeve resection.
RESULTS
The procedures of the six patients who underwent bronchoplasty or sleeve resection were as follows: lower sleeve bilobectomy (n = 3), wedge bronchoplasty of the bronchus intermedius (n = 1), isolated sleeve resection of the bronchus intermedius (n = 1), and isolated sleeve resection of the bronchus intermedius (n = 1), associated with a middle lobectomy. All patients were discharged after a median time of 11 days. At a median of 12 months from surgery, two patients remain alive with a preserved pulmonary function. Four patients died after a median time of 56 months from bronchoplasty of causes that were not related to surgery.
CONCLUSIONS
Bronchial reconstructions are challenging procedures that can be performed in highly specialized centers. Despite this, they can be considered a good strategy to obtain a definitive resolution of stenosis after lung transplantation.
Topics: Bronchi; Constriction, Pathologic; Humans; Lung Neoplasms; Lung Transplantation; Pneumonectomy
PubMed: 34431010
DOI: 10.1007/s00595-021-02360-z -
The Thoracic and Cardiovascular Surgeon Sep 2022Bronchial stenosis is a common complication following lung transplantation. We evaluated long-term associations of the use of self-expandable metal stents (SEMSs) with...
BACKGROUND
Bronchial stenosis is a common complication following lung transplantation. We evaluated long-term associations of the use of self-expandable metal stents (SEMSs) with lung function tests, patient safety, and survival.
METHODS
A retrospective chart review of 582 lung transplantations performed at our institution between January 2002 and January 2018. Fifty-four patients with SEMSs (intervention group) were matched one-to-one to patients without SEMSs (control group) using propensity score matching for age, sex, the year, and type of transplantation (unilateral/bilateral), and underlying disease. Data regarding long-term lung function and survival were compared between the groups.
RESULTS
During a median follow-up of 54.8 months, the difference in survival between the study groups was not statistically significant ( = 0.2). Following 5, 7.5 and 10 years, values of mean forced expiratory volume in 1 second (FEV1) were comparable between patients with and without SEMSs as follows: 59.5 versus 62.6% ( = 0.2), 55.9 versus 55.0% ( = 0.4), and 63.5 versus 61.9% ( = 0.3), respectively. In the intervention group, a significant increase in the mean FEV1 was observed in 60 days after stent insertion (from 41.9 ± 12.8 to 49.5 ± 16.7% days, < 0.001). Long-term complications following stent insertion included severe bleeding (1.8%), stent fractures (7.4%), stent stenosis (7.4%), stent collapse (3.7%), endobronchial pressure ulcer (1.9%), and stent migration (1.9%).
CONCLUSION
SEMS insertion is associated with a positive sustained effect on lung function, without increasing long-term mortality. Thus, airway stenosis after lung transplantation can be safely and successfully treated using endobronchial metal stenting, with tight bronchoscopic follow-up and maintenance.
Topics: Constriction, Pathologic; Humans; Lung; Retrospective Studies; Stents; Transplant Recipients; Treatment Outcome
PubMed: 33477176
DOI: 10.1055/s-0040-1721461 -
Anesthesiology Jan 2020
Topics: Bronchi; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Humans; Polyps; Smoke Inhalation Injury; Trachea; Tracheal Diseases
PubMed: 31834872
DOI: 10.1097/ALN.0000000000002972 -
Medicina (Kaunas, Lithuania) Mar 2021Tracheal or bronchial tears are potential complications of rigid bronchoscopy. This study aimed to investigate the acute complications and outcomes of using an...
Tracheal or bronchial tears are potential complications of rigid bronchoscopy. This study aimed to investigate the acute complications and outcomes of using an insulation-tipped (IT) knife in combination with rigid bronchoscopic dilatation for treating benign tracheobronchial stenosis. We conducted a chart review of patients with benign tracheobronchial stenosis who were treated with rigid bronchoscopy and an IT knife at two referral centers. Treatment success was defined as a clinically stable state without worsening symptoms after 3 months of treatment. Of the 23 patients with benign tracheobronchial stenosis, 15 had tracheal stenosis and 6 had main bronchial stenosis. Among them, three cases were of simple stenosis (13%), while the others were of complex stenosis (87%). The overall treatment success rate was 87.0%. Pneumomediastinum and subcutaneous emphysema occurred due to bronchial laceration in two cases of distal left main bronchial stenosis (8.7%), and no other significant acute complications developed. Silicone stents were inserted in 20 patients, and successful stent removal was possible in 11 patients (55.0%). Six of the seven stents inserted in patients with post-intubation tracheal stenosis were removed successfully (85.7%). However, most of the patients with post-tracheostomy tracheal stenosis required persistent stenting (80%). Pulmonary function was significantly increased after treatment, and the mean increase in the forced expiratory volume in 1 s was 391 ± 171 mL (160-700 mL). The use of an IT knife can be suggested as an effective and safe modality for rigid bronchoscopic treatment of benign tracheobronchial stenosis.
Topics: Bronchi; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Humans; Retrospective Studies; Stents; Tracheal Stenosis
PubMed: 33800300
DOI: 10.3390/medicina57030251 -
Therapeutic Advances in Respiratory... 2022Anastomotic complications are common after lung transplantation (1.4-33% of cases) and still associated with a high morbi-mortality.
BACKGROUND
Anastomotic complications are common after lung transplantation (1.4-33% of cases) and still associated with a high morbi-mortality.
METHODS
The current study is a monocenter retrospective analysis of symptomatic anastomotic complications (SAC) occurring after lung transplantation between 2010 and 2016, using the macroscopic, diameter, and suture (M-D-S) classification from consensus of French experts in bronchoscopy. The objectives were to determine incidence from surgery, risk factors, and impact of survival of SAC. We defined SAC as M-D-S abnormalities (stenosis ⩾ 50% or dehiscence) requiring bronchoscopic or surgical interventions.
RESULTS
A total of 121 patients were included. SAC occurred in 26.5% of patients ( = 32), divided in symptomatic stenosis for 23.7% ( = 29), and symptomatic dehiscence in 2.5% ( = 3). In multivariate analysis, donor bacterial lung infection [HR 2.08 (1.04-4.17), = 0.04] and age above 50 years [HR 3.26 (1.04-10.26), = 0.04] were associated with SAC occurrence. Cystic fibrosis etiology was associated with better survival on Kaplan-Meier curve ( < 0.001). SAC [HR 2.15 (1.07-4.32), = 0.03] was independently associated with worst survival. The 29 symptomatic patients because of stenosis required endoscopic procedure, of whom 16 patients needed bronchial stent placement. Four patients underwent surgery: three patients because of dehiscence and one because of severe bilateral stenosis (re-transplantation).
DISCUSSION
SAC occurred in 26.5% of patients. Donor lung infection was the only alterable identified factors. The increase rate of SAC in older patients above 50 years of age encourages in regular endoscopic monitoring.
Topics: Aged; Anastomosis, Surgical; Bronchi; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Humans; Incidence; Lung Transplantation; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Stents
PubMed: 35894432
DOI: 10.1177/17534666221110354 -
Journal of Thoracic Disease Jan 2017Blunt main stem bronchial injuries are rare but potentially life-threatening injuries in clinical. The aim of this study was to sum up the experience on diagnosis and...
BACKGROUND
Blunt main stem bronchial injuries are rare but potentially life-threatening injuries in clinical. The aim of this study was to sum up the experience on diagnosis and treatment of blunt main stem bronchial injuries.
METHODS
This report retrospective1y analyzed eight cases of main stem bronchial injuries induced by blunt chest trauma between 2013 and 2016 in Tangdu Hospital, Fourth Military Medical University.
RESULTS
There were eight patients, including four men and four women. The definitive diagnosis was confirmed by fibrobronchoscopy. Mean time between injury and treatment in our hospital was 4.25 days (range, 1-12 days). Mean length of airway tear was 1.04 cm (range, 0.5-2 cm). In four patients there was an injury to the left main stem bronchus, in three patients to the right main stem bronchus and in one patient to the ambilateral main stem bronchus. Emergent operation was performed in two patients and elective operation in six patients. End to end bronchial anastomosis was performed via right thoracotomy in two patients and via left thoracotomy in three patients, and primary repair was performed via right thoracotomy in two patients and via left thoracotomy in the remaining one patient. There was no death in this group. Seven patients had no complications and were able to take part in normal activities. One patient suffered from anastomotic stricture after operation was healed by granulation tissue resection and cryotherapy under fibrobronchoscopy.
CONCLUSIONS
Fibrobronchoscopy is able to define the blunt main stem bronchial injuries precisely and surgical approach is the preferred method for patients with these life-threatening complications.
PubMed: 28203423
DOI: 10.21037/jtd.2017.01.16