纤维蛋白塞引起的复发性肺不张是支气管热成形术的早期并发症:1例报告。

IF 2.3
Multidisciplinary Respiratory Medicine Pub Date : 2015-03-08 eCollection Date: 2015-01-01 DOI:10.1186/s40248-015-0002-7
Nicola Facciolongo, Francesco Menzella, Mirco Lusuardi, Roberto Piro, Carla Galeone, Claudia Castagnetti, Alberto Cavazza, Cristiano Carbonelli, Luigi Zucchi, Pier Paolo Salsi
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引用次数: 31

摘要

背景:支气管热成形术(BT)是一种新的治疗选择,用于在某些病例中,尽管高剂量吸入皮质类固醇、长效支气管扩张剂和奥玛珠单抗仍无法控制的严重难治性哮喘。文献中已经描述了严重哮喘患者接受BT治疗后肺不张的风险,但没有详细报道该并发症的可能机制。病例介绍:1例49岁男性重症哮喘患者,首次手术1小时后出现急性呼吸衰竭伴PaO2/FiO2。结论:本病例报告的独创性与连续两次BT手术后1小时和5小时内支气管堵塞伴肺大叶不张的复发有关。组织学检查显示支气管栓与典型的黏液性哮喘栓非常不同,主要由纤维蛋白组成。可以假设,对支气管粘膜的强烈热刺激可能对易感患者的炎症有强烈的促进作用,热直接或通过释放介质引起微血管改变。虽然在严重哮喘中,典型哮喘粘液样塞可能会导致肺不张的风险,但我们病例的特殊性在于纤维蛋白塞的形成,应考虑其与BT的直接相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Recurrent lung atelectasis from fibrin plugs as a very early complication of bronchial thermoplasty: a case report.

Recurrent lung atelectasis from fibrin plugs as a very early complication of bronchial thermoplasty: a case report.

Recurrent lung atelectasis from fibrin plugs as a very early complication of bronchial thermoplasty: a case report.

Recurrent lung atelectasis from fibrin plugs as a very early complication of bronchial thermoplasty: a case report.

Background: Bronchial thermoplasty (BT) is a new therapeutic option for severe refractory asthma not controlled despite high dose inhaled corticosteroids plus long-acting bronchodilators and omalizumab in selected cases. Risk of pulmonary atelectasis after BT in severe asthma has been described in literature, but no details have been reported on the possible mechanisms of the complication.

Case presentation: A 49-year-old male with severe uncontrolled asthma was referred to BT. One hour after the first procedure, acute respiratory failure occurred with PaO2/FiO2 < 300. A CT scan showed atelectasis of the right lower and middle lobes. A new bronchoscopy was performed under non-invasive ventilation; the right lower and middle lobe bronchus were occluded by bronchus-shaped plugs, that were very difficult to remove despite repeated saline washings and fragmentation with forceps. The patient had a rapid resolution of respiratory failure. Four weeks later, 6 hours after the second session of BT, severe bronchospasm occurred with respiratory failure. Chest X-Ray showed atelectasis of the left lower lobe, prompting to perform a new flexible bronchoscopy on non-invasive ventilation. The exam showed again a plug occluding the left lower lobar bronchus, removed with forceps and washings. The histological analysis of the plugs demonstrated the massive presence of fibrin with mucus debris, rare Charcot-Leyden crystals, scattered macrophages, neutrophils, eosinophils and bronchial epithelial cells.

Conclusion: The originality of our case report is related to the recurrence of bronchial plugging with lobar atelectasis within one and five hours respectively, after two sequential BT procedures. At the histological evaluation the bronchial plugs appeared very different from the typical mucoid asthma plugs, being composed prevalently by fibrin. It can be hypothesized that intense thermal stimulation of the bronchial mucosa may represent a strong boost for inflammation in susceptible patients, with microvascular alteration induced directly by heat or through the release of mediators. Although in severe asthma a risk of atelectasis from the classical asthma mucoid plugs may be expected, the peculiarity of our case resides in the formation of fibrin plugs whose direct correlation with BT should be considered.

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来源期刊
Multidisciplinary Respiratory Medicine
Multidisciplinary Respiratory Medicine Medicine-Pulmonary and Respiratory Medicine
自引率
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发文量
23
期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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