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BMC Pulm Med. 2019 Jul 2;19(1):119. doi: 10.1186/s12890-019-0873-z.

Case report of severe bronchial web-like stenoses after 'surviving the unsurvivable'.

Author information

1
Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia. thomas.crowhurst@gmail.com.
2
Department of Thoracic Medicine, Central Adelaide Local Health Network, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, 5000, Australia. thomas.crowhurst@gmail.com.
3
Intensive Care Unit, Central Adelaide Local Health Network, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, 5000, Australia.
4
Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
5
Department of Thoracic Medicine, Central Adelaide Local Health Network, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, 5000, Australia.
6
Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
7
Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
8
Department of Medicine, Monash University, Wellington Road, Clayton, Victoria, 3800, Australia.

Abstract

BACKGROUND:

There are few cases of multiple bronchial stenoses reported in the literature and none of the severity described here. The case is relevant due to its rareness, the pathophysiological insights derived, the successful interventional pulmonology strategies demonstrated, and as an example of a rare indication for high-risk lung transplantation.

CASE PRESENTATION:

A 47-year-old man developed multiple recurrent bronchial web-like stenoses five weeks after an episode of severe tracheo-bronchitis presumed secondary to a chemical inhalation injury which initially caused complete bilateral lung collapse necessitating veno-venous extracorporeal membrane oxygenation. The stenoses completely effaced bronchi in many locations causing severe type II respiratory failure requiring mechanical ventilation and bronchoscopic puncture / dilatation then ultimately bilateral lung transplantation.

CONCLUSION:

This very rare case highlights the morbid sequelae that can arise after catastrophic tracheobronchitis which now, in the era of extracorporeal membrane oxygenation, may be survivable in the short-term.

KEYWORDS:

Bronchial web-like stenoses; Extra-corporeal membrane oxygenation; Inhalation injury; Interventional pulmonology; Lung transplantation

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