Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

  • Lee, Hongyeul (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Leem, Cho Sun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Lee, Jae Ho (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Lee, Choon-Taek (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Cho, Young-Jae (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital)
  • Received : 2014.05.27
  • Accepted : 2014.06.25
  • Published : 2014.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in lifethreatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

Keywords

References

  1. Mindline J. Massive collapse of the lung complicating haemoptysis. Br Med J 1935;2:1201-40. https://doi.org/10.1136/bmj.2.3911.1201
  2. Allen RP, Siefkin AD. Emergency airway clot removal in acute hemorrhagic respiratory failure. Crit Care Med 1987;15:985-6. https://doi.org/10.1097/00003246-198710000-00021
  3. Botnick W, Brown H. Endobronchial urokinase for dissolution of massive clot following transbronchial biopsy. Chest 1994;105:953-4. https://doi.org/10.1378/chest.105.3.953
  4. Foucher P, Merati M, Baudouin N, Reybet-Degat O, Camus P, Jeannin L. Fatal ball-valve airway obstruction by an extensive blood clot during mechanical ventilation. Eur Respir J 1996;9: 2181-2. https://doi.org/10.1183/09031936.96.09102181
  5. Sakr L, Dutau H. Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management. Respiration 2010;80:38-58. https://doi.org/10.1159/000274492
  6. Manzano-Fernandez S, Pastor FJ, Marin F, Cambronero F, Caro C, Pascual-Figal DA, et al. Increased major bleeding complications related to triple antithrombotic therapy usage in patients with atrial fibrillation undergoing percutaneous coronary artery stenting. Chest 2008;134:559-67. https://doi.org/10.1378/chest.08-0350
  7. Arney KL, Judson MA, Sahn SA. Airway obstruction arising from blood clot: three reports and a review of the literature. Chest 1999;115:293-300. https://doi.org/10.1378/chest.115.1.293
  8. Bodenham AR. Removal of obstructing blood clot from the lower airway: an alternative suction technique. Anaesthesia 2002;57:40-3. https://doi.org/10.1046/j.1365-2044.2002.02273.x
  9. Vajo Z, Parish JM. Endobronchial thrombolysis with streptokinase for airway obstruction due to blood clots. Mayo Clin Proc 1996;71:595-6. https://doi.org/10.4065/71.6.595
  10. Roh JH, Park TS, Kim SY, Yoo JW, Park GM, Park SY, et al. Endobronchial hamartoma treated bronchoscopically: report of two cases. Korean J Med 2009;77:625-9.
  11. Lee SH, Choi WJ, Sung SW, Kim YK, Kim CH, Zo JI, et al. Endoscopic cryotherapy of lung and bronchial tumors: a systematic review. Korean J Intern Med 2011;26:137-44. https://doi.org/10.3904/kjim.2011.26.2.137
  12. Jung JY, Lee SY, Kim DH, Lee KJ, Lee EJ, Kang EH, et al. Clinical benefits and complications of cryotherapy in advanced lung cancer with central airway obstruction. Tuberc Respir Dis 2008;64:272-7. https://doi.org/10.4046/trd.2008.64.4.272
  13. Rubio E, Gupta P, Ie S, Boyd M. Cryoextraction: a novel approach to remove aspirated chewing gum. Ann Thorac Med 2013;8:58-9. https://doi.org/10.4103/1817-1737.105721
  14. De Weerdt S, Noppen M, Remels L, Vanherreweghe R, Meysman M, Vincken W. Successful removal of a massive endobronchial blood clot by means of cryotherapy. J Bronchol 2005;12:23-4. https://doi.org/10.1097/00128594-200501000-00007
  15. Kantsevoy SV, Cruz-Correa MR, Vaughn CA, Jagannath SB, Pasricha PJ, Kalloo AN. Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study. Gastrointest Endosc 2003;57:403-6. https://doi.org/10.1067/mge.2003.115

Cited by

  1. Combination of bronchoscopic cryoextraction and argon plasma coagulation in treatment of total central airway obstruction caused by giant blood clot formation in massive airway bleeding vol.19, pp.None, 2016, https://doi.org/10.1016/j.rmcr.2016.06.002
  2. Organized blood clot masquerading as endobronchial tumor: A review of management and recent advances vol.24, pp.None, 2014, https://doi.org/10.1016/j.rmcr.2018.05.020
  3. The use of bronchoscopy in critically ill patients: considerations and complications vol.12, pp.8, 2018, https://doi.org/10.1080/17476348.2018.1494576
  4. Bronchial cast extrication in an intubated and ventilated patient vol.12, pp.11, 2014, https://doi.org/10.1136/bcr-2019-232181
  5. Interventional Pulmonology vol.30, pp.3, 2014, https://doi.org/10.1016/j.thorsurg.2020.04.001
  6. Review of a 10-year experience of rigid bronchoscopy at a tertiary centre in Singapore vol.4, pp.3, 2020, https://doi.org/10.23838/pfm.2020.00023