Endobronchial Metastases of Renal Cell Carcinoma: A Complex Multidisciplinary Treatment

Franco Ravenna, Valentina Conti, Elisabetta Salviato, Elisabetta Marangoni, Marco Verri, Michele Paolazzi, Roberto Galeotti, Gaetano Caramori

Abstract


We report a case of endobronchial metastases of renal cell carcinoma, treated with rigid bronchoscopy and laser resection followed by bronchial artery embolization, in a 56-year-old Caucasian man, presenting with dyspnea, cough, and hemoptysis. Computed tomography of the chest and flexible bronchoscopy showed a large mass under the tracheal carina causing complete occlusion of the left main bronchus and subtotal (90%) occlusion of the right main bronchus, with saving of the homolateral lobar bronchi. The right main bronchus stenosis was removed during rigid bronchoscopy using neodymium-doped yttrium aluminum garnet laser and mechanical disruption. The procedure caused persistent bleeding, for this reason the right main bronchus was selectively intubated and bronchial arterial embolization was performed with arrest of the bleeding. After 3 days of Intensive Care Unit stay a bronchoscopy performed a day later documented the complete reopening of the right main bronchus. In conclusion, bronchial arterial embolization should be considered as another treatment option in endobronchial metastases of highly vascularized tumors such as renal cell carcinoma that often cause bleeding during their endoscopic resection.




J Med Cases. 2013;4(9):644-647
doi: http://dx.doi.org/10.4021/jmc1371w


Keywords


Bronchial artery embolization; Interventional bronchoscopy; Renal cell carcinoma; Bleeding; Rigid bronchoscope

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