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A6463 - ​Treated Bronchoscopy with Cryotherapy in Patient with Broncholithiasis - Case Report
Author Block: L. V. dos Reis1, L. P. Bruno2, R. E. Salles2, T. T. Mafort3, D. M. Ferraz4; 1Pneumolology, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil, 2Pneumologia, Universidade do estado do Rio de Janeiro, Rio de Janeiro, Brazil, 3HOSPITAL UNIVERSITÁRIO PEDRO ERNESTO, RIO DE JANEIRO, Brazil, 4Pulmonology, University Rio de Janeiro State, Rio de Janeiro, Brazil.
Introduction: Cryotherapy is a modality within the arsenal of bronchoscopy that allows diagnosis and treatment of pulmonary diseases, in which a cryosonde is used to freeze lung fragments, being transbronchial or endobronchial. This method has been increasingly used in those patients who are not eligible for treatment or surgical biopsy, making it possible to reduce the length of hospital stay and an acceptable rate of complications. Case report: Female, 45 years old,afro-american, nurse, 2 years ago was treated with latent Tuberculosis with Isoniazid for 6 months, after evidence of strong PPD reactor. For 1 year, the patient presented with intermittent fever, productive cough and exertional dyspnea. Chest tomography demonstrating atelectal consolidation in the middle lobe (ML) associated with hilar, infracarinal and inferior paratracheal lymph node enlargement with central calcification, as well as bronchial calcifications. Bronchofibroscopy evidencing enlargement of the main carina, exophytic lesion occluding the entrance of MLB with exit of white and thick secretion. Endobronchial biopsy was performed in MLB. Histopathological evidencing chronic and acute inflammatory process, negative for malignancy. Tuberculosis, mycobacteriosis and negative fungal infections, both in bronchial lavage and other tests. Lymph node puncture by endobronchial ultrasonography (EBUS) was also inconclusive. Re-treatment with cryostat was performed, new tissue sae end of the procedure. After removal of fragments from the exophytic lesion, fragments of a calcium-like appearance (broncolytes) appeared that were similarly removed with the cryoprobe. New bronchoscopy after one week of the procedure evidencing patent BLM. Discussion: Cryotherapy is an innovative method that allows the treatment of benign and malignant endobronchial lesions, as well as allowing the diagnosis of parenchymal (interstitial and alveolar) diseases as an alternative to surgical biopsy, with lower mortality and complications. Broncholithiasis is defined as the presence of calcified material (ossification) in the lumen of the tracheobronchial tree, an uncommon complication in Tuberculosis. Complete closure of the bronchus can occur, compromising quality of life and lung function. Bronchial recanalization is necessary in those patients who have recurrent infections or who are symptomatic.