Management of right upper airway patency by a silicon stent in a case of endobronchial metastasis

Summary 

Background

Endobronchial metastasis from an extrapulmonary malignancy is relatively rare. There have been no previous reports of airway stenting to salvage right upper lobe airway patency.

Case report

This report describes a 76-year-old male who suffered from a huge endobronchial tumor with a history of renal cell carcinoma (RCC). The endobronchial tumor was thought to have invaded the right main bronchus from a metastasis of the lung parenchyma and the tumor was estimated to have considerable vascularity by contrast enhanced computed tomography. The patient underwent external irradiation, endobronchial tumor reduction with a flexible bronchoscope, transcatheter bronchial arterial embolization and then a successful endobronchial tumor resection by rigid bronchoscopy. The endobronchial tumor resection was mainly achieved using an electrosurgical snare. Furthermore, a Y-shaped Dumon stent was implanted at the bifurcation of the right upper lobe bronchus and bronchus intermedius for the management of complete right airway patency.

Conclusions

The tumor was successfully resected using a multidisciplinary approach and a novel method of silicone stent placement using the usual rigid bronchoscopic technique was employed to maintain complete right airway patency.

Keywords: Endobronchial metastasis, Renal cell carcinoma, Electrosurgical snare, Bronchial arterial embolization, Silicone stent, Interventional pulmonology