Page 88 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED VIDEO SESSION
A BLUE VOLCANIC ERUPTION
Rebeca Martins Natal1, Rita Aragão2, Ana Catarina Almeida2, Telma Sequeira2, Ambrus Szantho2, Jorge Dionísio2
1 Pulmonology Department, Sousa Martins Hospital, Local Health Unit of Guarda, Guarda, Portugal
2 Pulmonology Department, Portuguese Institute of Oncology of Lisbon Francisco Gentil, Lisbon, Portugal
VID01
Introduction: As an Oncology Institute, we perform routinely bronchoscopies for oesophageal cancer staging. We present a case of a 56-year-old male patient, with a recently diagnosed squamous cell carcinoma of the oesophagus, located 25 cm from the dental arch.Thoracic computed tomography images did not reveal an involvement of the tracheobronchial tree. This patient was sent to the bronchoscopy unit for endobronchial staging. Four days before the exam, the patient complained of choking sensation and cough immediately after fluid intake.
Aim: We present a didactic video of a flexible bronchoscopy using methylene blue instillation where a tracheoesophageal fistula was detected.
Methods: A flexible bronchoscopy was performed under moderate sedation, with an Olympus® EVIS H190 bronchoscope, entered via the left nasal cavity.An oxygen catheter was inserted into the oesophagus under bronchoscopic visualization at a distance of nearly 21 cm from the dental arch. Methylene blue was instillated by this probe while watching the trachea.
Results: The bronchoscopy revealed hyperemic tracheal mucosa with multiple secretions forming thick whitish plates. About 2 cm above the carina, two contiguous cone-shaped protuberances with a whitish end arising from the posterior wall of the trachea were observed (Choi Basi classification III). Tracheoesophageal fistulae were not evident. Distal bronchial tree was normal with an anatomical variance of the right upper lobe.After the insertion of the oxygen catheter into the oesophagus, the methylene blue was instillated, which resulted in an immediate projection through tracheal protuberances, allowing the detection of a tracheoesophageal fistula.
Conclusion: Methylene blue instillation remains a practical, easy and fast method to endoscopically confirm the presence of poorly visualized tracheoesophageal fistulae.
VID02
Introduction: Foreign-body aspiration (FBA) is often a serious medical condition that needs early detection and intervention. It can be a life-threatening event if it leads to complete obstruction. Precipitating factors for such aspiration include altered consciousness, intoxication, seizures, dental procedures, facial trauma and intubation. When FBA is suspected, a rigid or flexible bronchoscopy can be performed, but debate remains which one is the optimal procedure.
Clinical case: The authors report a case of a 45-year-old female brought to the emergency department of our hospital after polytrauma from attempted suicide from 8m height. Due to extensive maxillofacial trauma, she was intubated at admission to secure the airway and subsequently operated with exodontia of fractured dental pieces and re-operated one day after with reduction and osteosynthesis of the jaw. There were no signs of postoperative complications and after clinical improvement sedation was reduced and the patient was extubated.The day after extubation the patient developed severe respiratory insufficiency with decreased respiratory sounds on the right hemithorax. She was re- intubated with aid of a flexible intubating scope, which also allowed identification of a loose dental piece in the lower airways. At this point Pneumology evaluation was requested and flexible bronchoscopy was performed. A single-use flexible bronchoscope with video technology was introduced via endotracheal tube and progressed to the right inferior bronchus where the endobronchial fractured tooth was visualized in the lateral basal branch (RB9). With the help of biopsy forceps, the object was carefully and gently pulled under direct vision, avoiding the bronchial walls. After multiple attempts the tooth was step-wise brought closer to the central airway. Due to its shape and size, it was not possible to remove it through the endotracheal tube and for this reason it was tried to be removed “en bloc”- bronchoscope, tooth and endotracheal tube. Despite this, it deposited in the oropharynx and it was necessary to be removed with the aid of a laryngoscope, while re-intubated. P. Aeruginosa nosocomial pneumonia ensued and antibiotic therapy directed to sensitivities was started.There was a good clinical evolution and the patient was successfully extubated.
Conclusion: Many bronchologists consider rigid bronchoscopy as the treatment of choice for foreign body aspirations since it is extremely effective and has a low complication risk. However, more studies and cases arise in which flexible bronchoscopy can safely and effectively remove foreign objects from the airways, as this case exemplifies.
ENDOBRONCHIAL TOOTH REMOVAL USING SINGLE-USE FLEXIBLE BRONCHOSCOPE
Ricardo Quita, Diana Mano, Nuno Faria, Bruno Silva, Fernando Guedes
Centro Hospitalar e Universitário do Porto, Porto, Portugal
88 6th European Congress for Bronchology and Interventional Pulmonology