Use of 3-D navigation to target the site of autologous bloodinstallation for lung volume reduction in bullous emphysema

摘要

Bronchoscopic lung volume reduction (BLVR) using intrabullous autologous bloodinstillation has been reported in single cases where other techniques are notpossible. We present the use of three-dimensional navigation to instillautologous blood into emphysematous bullae for BLVR. A 62-year-old man presentedwith increasing dyspnea, due to emphysema with a conglomerate of giant bullaewith two particularly large bullae. Surgical treatment was refused, sobronchoscopic autologous blood instillation into the bronchial segment leadingto the large bullae was attempted, but was unsuccessful; blood failed topenetrate into the bullous cavity. Dyspnea worsened over the following year. Wetherefore performed another bronchoscopy and punctured a large bulla with aneedle and created a tunnel from the central airways. Puncture position anddirection were determined using a prototype of an electromagnetic navigationsystem. Under fluoroscopic guidance, a catheter was placed via the tunnel intothe bulla and blood was instilled. This resulted in an almost complete shrinkageof the bullae, reduction of residual volume, and marked improvement in dyspneawithin 4 months. To our knowledge, this is the first reported case of successfulBLVR by navigated bronchoscopy with transbronchial puncture, dilatation, andautologous blood instillation into a giant bulla.