Serious Complications after Self-expandable Metallic Stent Insertion in a Patient with Malignant Lymphoma

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.

Keywords: Airway Obstruction; Bronchoscopy; Granulation Tissue; Stents.

Figure 1

Initial chest radiography shows atelectasis of left lower lung field and metallic stents are placed at both main bronchus (arrows).

Figure 2

The stents are deployed at both main bronchi, the left bronchial stent (arrow) is obstructed and left lower lobe is collapsed as a result (A, C). The lumen of the right stent (arrow) is intact (B, D).

Figure 3

The covered-self expandable metallic stent is retrieved in fragments.

Figure 4

(A) The silicone stents are placed at both main bronchus. (B) Left lower lobe collapse is improved after silicone stent insertion.