Presentation
Previous lung transplant years before. Stable SOB. Clinic follow up.
Patient Data
Left-sided PICC line in situ. A metallic stent is projected in the right main bronchus. Moderately sized right pleural effusion, right patchy consolidation and left lower lobe subsegmental atelectasis persists and is stable compared to the CXR from one week prior. No new findings.
Case Discussion
This patient received a lung transplant and developed flow-limiting stenosis of the right main bronchus 3 months after transplant which was successfully treated with bronchoscopic stenting.
Bronchial stenosis post lung transplant is most commonly due to post-operative ischemia of the donor bronchial stump. It is associated with necrosis, dehiscence and infection and surprisingly is not always symptomatic.
Stenting is a successful treatment strategy for stenosis, usually performed after bronchoscopic dilatation is unsuccessful. Stent complications include mucous retention, stent colonization and lobar pneumonia, which typically occur in the first year. Stent removal can be difficult, complicated by epithelial overgrowth. Some centers advocate stent removal at 6 months.
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