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It's better to be lucky ?¢???| successful management of an acute endobronchial tumour embolism in the ICU: a case report and review of the literature

机译:最好是幸运的?在ICU中成功治疗急性支气管内肿瘤栓塞:一例病例报告并文献复习

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摘要

Abstract Endobronchial tumour embolism is a rare cause of acute central airway obstruction. It is primarily reported during pneumonectomy, and the outcome is frequently fatal. Successful management requires the urgent removal of tumour with rigid or flexible bronchoscopy. We present the case of a 62-year-old woman with poorly differentiated non-small cell lung cancer (NSCLC), referred to our institution for Nd:YAG laser photoresection of endobronchial tumour completely obstructing the right mainstem bronchus (RMSB). Soon after admission, our patient developed critical hypoxemia, rapidly followed by cardiac arrest. Bronchoscopy was urgently performed and revealed a necrotic tumour occluding the left mainstem bronchus (LMSB), with some residual tumour and clot at the RMSB. The tumour acutely obstructing the LMSB was successfully extracted using a foreign body retrieval basket and large flexible biopsy forceps via a large (therapeutic) flexible bronchoscope. Ventilation immediately improved, with the return of a pulse, and the patient was successfully extubated the next day. Pathology of the tumour embolism revealed NSCLC with necrosis and an adherent clot. Here, we review 16 published reports of endobronchial tumour embolism in relation to our case.
机译:摘要支气管内肿瘤栓塞是急性中央气道阻塞的罕见原因。主要在肺切除术中报道,其结果通常是致命的。成功的治疗需要用刚性或柔性支气管镜紧急清除肿瘤。我们介绍了一名分化不良的非小细胞肺癌(NSCLC)的62岁女性的案例,该病例转诊至我们的Nd:YAG激光支气管内镜肿瘤切除术,完全阻塞了右主干支气管(RMSB)。入院后不久,我们的患者出现严重的低氧血症,随后迅速出现心脏骤停。紧急进行了支气管镜检查,发现坏死性肿瘤闭塞了左主支气管(LMSB),RMSB处有一些残留的肿瘤和凝块。使用异物取出篮和大型柔性活检钳通过大型(治疗性)柔性支气管镜成功提取了严重阻塞LMSB的肿瘤。通气立即恢复,脉搏恢复,患者第二天成功拔管。肿瘤栓塞的病理显示NSCLC伴有坏死和粘连的血块。在这里,我们回顾了与我们的病例有关的16篇关于支气管内肿瘤栓塞的公开报道。

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