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Lee, Yim, Kim, Shin, and Oh: A Case of Bronchial Obstruction Due to Bronchial Angulation after Upper Lobectomy
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(3): 216-219.

Published online: 31 March 2009

DOI: https://doi.org/10.4046/trd.2009.66.3.216

A Case of Bronchial Obstruction Due to Bronchial Angulation after Upper Lobectomy

Ho-Su Lee, M.D.1, Ji-Hye Yim, M.D.1, Woo-Jin Kim, M.D.4, Ji-Hoon Shin, M.D.3, Yeon-Mok Oh, M.D.2

1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

3Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

4Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea.

Address for correspondence: Yeon-Mok Oh, M.D. Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3136, Fax: 82-2-3010-6968, ymoh55@amc.seoul.kr

Received 12 September 2008       Accepted 12 December 2008

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

A bronchial obstruction of the remaining lung is a rare complication of thoracic surgery. We report a case of this rare complication after a right upper lobectomy due to a giant bulla. Post-resectional angulation of the bronchus intermedius caused the bronchial obstruction. An intrabronchial stent was inserted into the bronchus intermedius, which relieved the obstruction.

Keywords: Lobectomy, Obstruction, Stents

Figures and Tables

Figure 1
Bronchoscopic finding at the right bronchus intermedius. Pictures at the proximal portion of the bronchus intermedius (A) and at the site of the angulation (B) showed a near total obstruction of right bronchus intermedius.
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Figure 2
Three dimensional CT of trachea and bronchi. Three dimensional CT scan showed a pin point narrowing at the distal bronchus intermedius.
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Figure 3
Insertion of a metal stent. A bare metal stent (10 mm×3 cm) was inserted at the bronchus intermedius.
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Figure 4
Bronchoscopic findings of the inserted metal stent. Pictures at the proximal portion of the bronchus intermedius (A) and at the site of the angulation (B) showed that the stent relieved the obstruction of right bronchus intermedius.
trd-66-216-g004

References

1. Van Leuven M, Clayman JA, Snow N. Bronchial obstruction after upper lobectomy: kinked bronchus relieved by stenting. Ann Thorac Surg. 1999. 68:235–237.
2. Korst RJ, Humphrey CB. Complete lobar collapse following pulmonary lobectomy: its incidence, predisposing factors, and clinical ramifications. Chest. 1997. 111:1285–1289.
3. Ferguson MK, Durkin AE. A comparison of three scoring systems for predicting complications after major lung resection. Eur J Cardiothorac Surg. 2003. 23:35–42.
4. Cable DG, Deschamps C, Allen MS, Miller DL, Nichols FC, Trastek VF, et al. Lobar torsion after pulmonary resection: presentation and outcome. J Thorac Cardiovasc Surg. 2001. 122:1091–1093.
5. Kanemitsu S, Tanaka K, Suzuki H, Tokui T, Kinoshita T. Pulmonary torsion following right upper lobectomy. Ann Thorac Cardiovasc Surg. 2006. 12:417–419.
6. Sundaramoorthi T, Hashim S, Dillon P, Ramachandra R, Collins FJ, Rosin MD. An unusual cause of breathlessness after lobectomy for lung cancer. Ann Thorac Surg. 2004. 78:e13–e14.
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