Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Serious Complications after Self-expandable Metallic Stent Insertion in a Patient with Malignant Lymphoma

  • Cho, Sung Bae (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cha, Seon Ah (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Joon Young (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jong Min (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Hyeon Hui (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Moon, Hwa Sik (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sei Won (Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yeo, Chang Dong (Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Sang Haak (Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2014.08.06
  • Accepted : 2014.09.24
  • Published : 2015.01.30
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Abstract

An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.

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References

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