Tuberc Respir Dis.  2014 Oct;77(4):193-196. 10.4046/trd.2014.77.4.193.

Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

• Lee H
• Leem CS
• Lee JH
• Lee CT
• Cho YJ

• KMID: 2320578
• DOI: http://doi.org/10.4046/trd.2014.77.4.193

Abstract

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

Keyword

Bronchi; Bronchoscopy; Cryotherapy; Hemorrhage

MeSH Terms

Aged
Airway Obstruction
Bronchi
Bronchoalveolar Lavage
Bronchoscopy
Cryotherapy*
Drug Therapy
Endometrial Neoplasms
Female
Fever
Hemoptysis
Hemorrhage
Humans
Intensive Care Units*
Radiography
Respiration, Artificial
Surgical Instruments
Thorax
Ventilation

Figure

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  Figure 1 Chest radiography showed a completely opacified left hemithorax.

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  Figure 2 Left main bronchus obstructed by blood clots.

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  Figure 3 (A, B) Bronchoscopic cryotherapy.

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  Figure 4 Four large blood clots removed by bronchoscopic cryotherapy.

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  Figure 5 Follow-up chest X-ray revealed significant improvement in the aeration of the left lung.

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