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Use of a Silicone Endobronchial Spigot for Massive Refractory Hemoptysis
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A6457 - Use of a Silicone Endobronchial Spigot for Massive Refractory Hemoptysis
Author Block: T. Leclair, V. K. Holden, M. S. Parikh, A. Majid, A. C. M. Chee; Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Introduction: Massive Hemoptysis is a potentially life threatening condition which requires immediate intervention. Though routinely treated with bronchial artery embolization, if this fails, surgical interventions may be considered. In patients where surgery is not an option very few treatment modalities can be offered. Case: Here we present a case of a 54 year-old male admitted with syncope. He underwent aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting to the right coronary artery. His hospital course was complicated by cardiac tamponade, cardiogenic shock, renal failure requiring dialysis, and respiratory failure requiring tracheostomy. Subsequently, he developed recurrent hemoptysis isolated to the lingular lobe. In the absence of endobronchial or parenchymal abnormality to explain the bleeding, negative serologic workup for vasculitis, and culture data from a bronchial alveolar lavage which was unremarkable, he underwent embolization of the common bronchial artery, and then the lateral intercostal artery and left internal mammary lateral branch after he continued to bleed. Despite embolization, he continued to have hemoptysis so we occluded the lingula with two 6 mm diameter silicones spigots (Endobronchial Wantanabe Spigot, EWS®, Novatech, La Ciotat, France), via flexible bronchoscope and forceps. These spigots remained for 2 months and were removed after the patient developed lingular lung collapse, and pneumonia, which was successfully treated. He had no further hemoptysis. Discussion: Silicone spigots were originally created for use in treatment of broncho/alveolar pleural fistula, and persistent pneumothorax1. There has been one case report using a spigot for endobronchial embolization as a bridge to arterial embolization after which the spigots were immediately removed2. Here we present a case where spigots were employed to successfully stop hemoptysis after failed arterial embolization in a non-surgical candidate, and they remained safely in place for a long duration with easy removal. Currently these spigots are no longer commercially available. Further research is needed to evaluate whether they may be useful in situations other than their original design.
1. Watanabe Y. et al. Bronchial Occlusion with Endobronchial Watanabe Spigot, J Bronchol., 10, 4, 2003 2. H. Dutau et al. Endobronchial Embolization with a Silicone Spigot as a Temporary Treatment for Massive Hemoptysis. Respiration DOI:101159/000092954, published online April 21, 2006
Author Block: T. Leclair, V. K. Holden, M. S. Parikh, A. Majid, A. C. M. Chee; Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Introduction: Massive Hemoptysis is a potentially life threatening condition which requires immediate intervention. Though routinely treated with bronchial artery embolization, if this fails, surgical interventions may be considered. In patients where surgery is not an option very few treatment modalities can be offered. Case: Here we present a case of a 54 year-old male admitted with syncope. He underwent aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting to the right coronary artery. His hospital course was complicated by cardiac tamponade, cardiogenic shock, renal failure requiring dialysis, and respiratory failure requiring tracheostomy. Subsequently, he developed recurrent hemoptysis isolated to the lingular lobe. In the absence of endobronchial or parenchymal abnormality to explain the bleeding, negative serologic workup for vasculitis, and culture data from a bronchial alveolar lavage which was unremarkable, he underwent embolization of the common bronchial artery, and then the lateral intercostal artery and left internal mammary lateral branch after he continued to bleed. Despite embolization, he continued to have hemoptysis so we occluded the lingula with two 6 mm diameter silicones spigots (Endobronchial Wantanabe Spigot, EWS®, Novatech, La Ciotat, France), via flexible bronchoscope and forceps. These spigots remained for 2 months and were removed after the patient developed lingular lung collapse, and pneumonia, which was successfully treated. He had no further hemoptysis. Discussion: Silicone spigots were originally created for use in treatment of broncho/alveolar pleural fistula, and persistent pneumothorax1. There has been one case report using a spigot for endobronchial embolization as a bridge to arterial embolization after which the spigots were immediately removed2. Here we present a case where spigots were employed to successfully stop hemoptysis after failed arterial embolization in a non-surgical candidate, and they remained safely in place for a long duration with easy removal. Currently these spigots are no longer commercially available. Further research is needed to evaluate whether they may be useful in situations other than their original design.
1. Watanabe Y. et al. Bronchial Occlusion with Endobronchial Watanabe Spigot, J Bronchol., 10, 4, 2003 2. H. Dutau et al. Endobronchial Embolization with a Silicone Spigot as a Temporary Treatment for Massive Hemoptysis. Respiration DOI:101159/000092954, published online April 21, 2006
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