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• W4387247923 abstract "SESSION TITLE: Procedures Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Airway stents play a major role in relieving airway compression. A key element of stent placement is the demonstration of distal airway viability. This ensures that the stent is aiding the ventilation of recruitable lung tissue while preventing airway obstruction. Demonstrating airway viability can be challenging in cases of severe malignant airway obstruction due to accompanying post-obstructive pneumonia and resultant inflammation and edema. We present a challenging case where gentle oxygen insufflation under fluoroscopy was used to demonstrate airway viability and helped in the placement of telescoping stents to re-establish airway patency. CASE PRESENTATION: A 68-year-old man presented with a 4.2 cm X 4.6 cm right hilar mass invading the right main stem bronchus with partial airway occlusion. A workup done at an outside hospital confirmed the partially obstructing mass ultimately diagnosed as IIIB (T4N2M0) right upper lobe squamous cell lung cancer and deemed unresectable. Concurrent chemo-radiation was planned but shortly after diagnosis, he was admitted with acute hypoxic respiratory failure requiring 15L/min of supplemental oxygen. The chest CT scan showed a complete right lung collapse. Rigid bronchoscopy (13.2 mm OD) confirmed complete right main stem obstruction that was predominantly extrinsic. Balloon dilation was performed in the right main stem bronchus using a CRE balloon and pulmonary Jag wire under fluoroscopy guidance. The distal airways were not completely visible bronchoscopically. Gentle oxygen insufflation at 2 LPM with periodic pauses was used to the aeratable lung that could be ventilated under fluoroscopy. A 10 mm X 38 mm iCast stent (Atrium medical corporation, NH, USA) was placed in the bronchus intermedius under fluoroscopic guidance. To stabilize the proximal right main stem bronchus, a 12mm X 30mm Ultraflex tracheobronchial stent (Boston Scientific, MA, USA) was placed in the right main stem bronchus telescoping into the iCast stent. Balloon dilation was performed in the right main stem bronchus of the lung using a CRE balloon. Post-procedure chest imaging showed interval significant improvement in the aeration of the right middle and lower lobes with oxygen saturation of 97% on room air. Emergent palliative radiation was initiated. A repeat bronchoscopy after 2 months of radiotherapy revealed a near-complete tumor response and the telescoping stents were removed. DISCUSSION: Every attempt should be made to assess viable airways in patients with recent onset airway obstruction and resultant atelectasis. Such interventions can improve the quality of life and the ability to tolerate systemic or local anti-cancer therapy. CONCLUSIONS: Gentle oxygen insufflation with caution can be used to demonstrate airway viability and aid the placement of tracheobronchial stents to establish airway patency. REFERENCE #1: Ranu H, Madden BP. Endobronchial stenting in the management of large airway pathology. Postgrad Med J. 2009 Dec;85(1010):682-7. doi: 10.1136/pgmj.2009.089011. PMID: 20075408 REFERENCE #2: Herth FJ, Eberhardt R. Airway stent: what is new and what should be discarded. Curr Opin Pulm Med. 2016 May;22(3):252-6. doi: 10.1097/MCP.0000000000000266. PMID: 26907718. DISCLOSURES: No relevant relationships by Momen Banifadel No relevant relationships by Tanmay Panchabhai No relevant relationships by Benjamin Young" @default.
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• W4387247923 date "2023-10-01" @default.
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• W4387247923 title "OXYGEN INSUFFLATION TECHNIQUE TO DEMONSTRATE AIRWAY VIABILITY AND AID STENT PLACEMENT IN A CASE OF COMPLETE MALIGNANT RIGHT MAIN STEM BRONCHIAL OBSTRUCTION" @default.
• W4387247923 doi "https://doi.org/10.1016/j.chest.2023.07.3482" @default.
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