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A novel endobronchial approach to massive hemoptysis complicating silicone Y-stent placement for tracheobronchomalacia: A case report.

Abstract Airway stabilization for severe, symptomatic tracheobronchomalacia (TBM) may be accomplished by silicone Y-stent placement. Common complications of the Y-stent include mucus plugging and granulation tissue formation.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29465600
OWN - NLM
STAT- MEDLINE
DCOM- 20180302
LR  - 20180302
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 8
DP  - 2018 Feb
TI  - A novel endobronchial approach to massive hemoptysis complicating silicone
      Y-stent placement for tracheobronchomalacia: A case report.
PG  - e9980
LID - 10.1097/MD.0000000000009980 [doi]
AB  - RATIONALE: Airway stabilization for severe, symptomatic tracheobronchomalacia
      (TBM) may be accomplished by silicone Y-stent placement. Common complications of 
      the Y-stent include mucus plugging and granulation tissue formation. PATIENT
      CONCERNS: We describe a rare case of massive hemoptysis originating from a
      silicone Y-stent placed for TBM. DIAGNOSES: An emergent bronchoscopy showed an
      actively bleeding, pulsatile vessel at the distal end of the left bronchial limb 
      of the Y-stent. It was felt that the bleeding was caused by, or at least impacted
      by, the distal left bronchial limb of the Y-stent eroding into the airway wall.
      INTERVENTIONS: We hypothesized that placement of oxidized regenerated cellulose
      (ORC) would provide initial hemostasis, and the subsequent placement of a
      biocompatible surgical sealant would lead to definitive resolution. OUTCOMES: ORC
      provided sufficient hemostasis and the subsequent synthetic polymer reinforced
      the tissue for complete cessation of the bleed. LESSONS: The combined use of ORC 
      and a biocompatible surgical sealant provided long-term management for
      life-threatening hemoptysis, and potentially morbid procedures such as
      embolization or surgery were avoided by advanced endobronchial therapy.
FAU - Ryu, Changwan
AU  - Ryu C
AD  - Yale School of Medicine, Department of Internal Medicine, Section of Pulmonary,
      Critical Care, and Sleep Medicine.
FAU - Boffa, Daniel
AU  - Boffa D
AD  - Yale School of Medicine, Department of Thoracic Surgery, New Haven, CT, USA.
FAU - Bramley, Kyle
AU  - Bramley K
AD  - Yale School of Medicine, Department of Internal Medicine, Section of Pulmonary,
      Critical Care, and Sleep Medicine.
FAU - Pisani, Margaret
AU  - Pisani M
AD  - Yale School of Medicine, Department of Internal Medicine, Section of Pulmonary,
      Critical Care, and Sleep Medicine.
FAU - Puchalski, Jonathan
AU  - Puchalski J
AD  - Yale School of Medicine, Department of Internal Medicine, Section of Pulmonary,
      Critical Care, and Sleep Medicine.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Cellulose, Oxidized)
RN  - 0 (Hemostatics)
RN  - 0 (Silicones)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Bronchoscopy/*methods
MH  - Cellulose, Oxidized/administration & dosage
MH  - Female
MH  - Hemoptysis/etiology/*surgery
MH  - Hemostasis, Endoscopic/*methods
MH  - Hemostatics/administration & dosage
MH  - Humans
MH  - Prosthesis Implantation/instrumentation/methods
MH  - Silicones
MH  - Stents/*adverse effects
MH  - Tracheobronchomalacia/complications/*surgery
EDAT- 2018/02/22 06:00
MHDA- 2018/02/22 06:00
CRDT- 2018/02/22 06:00
PHST- 2018/02/22 06:00 [entrez]
PHST- 2018/02/22 06:00 [pubmed]
PHST- 2018/02/22 06:00 [medline]
AID - 10.1097/MD.0000000000009980 [doi]
AID - 00005792-201802230-00065 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Feb;97(8):e9980. doi: 10.1097/MD.0000000000009980.