B80-6-08 When the Stent Goes Rogue: A Rare Case of Svc-tracheal Fistula Formation

Introduction Superior vena cava (SVC) stenting is widely recognized as the first-line intervention for SVC syndrome, particularly in malignant obstruction. It provides rapid symptom relief and has a favorable safety profile, with reported complication rates around 6%. Although uncommon, complications include stent migration, thrombosis, bleeding, and rarely perforation. We describe a rare case of SVC stent erosion into the trachea following treatment of SVC syndrome secondary to malignancy. Case Description A 73-year-old male with stage IV NSCLC presented to the pulmonology clinic with worsening dyspnea, intermittent fever, and productive cough. He denied chest pain or tightness and remained hemodynamically stable on room air. He had recently completed an unsuccessful two-week course of azithromycin. His malignancy was previously complicated by superior vena cava (SVC) syndrome, for which a 12 mm × 5 cm bare-metal stent was placed twenty-nine months prior. Chest CT revealed erosion of the SVC stent into the anterior trachea and right mainstem bronchus, with gas extending from the trachea into the SVC and gas within the stent lumen and surrounding tissues. Repeat contrasted imaging confirmed these findings and demonstrated chronic stent occlusion with collateral venous drainage. Bronchoscopy showed a fistulous tract with visible pacer wires, peripheral venous catheter, and SVC stent eroding through the airway wall. Surgical repair was not indicated. The patient was managed with targeted antibiotics and palliative airway stenting was planned. He died a month later before definitive intervention could be performed. Discussion To our knowledge, this represents only the second reported case of SVC-tracheal fistula secondary to stent erosion. Both cases demonstrated intravascular gas on CT and were confirmed by bronchoscopy. However, the clinical presentations differed significantly: the prior case presented within three months with septic shock and hemoptysis while our patient did not develop symptoms until 29 months following stent placement. Clinicians should maintain a high index of suspicion in any patient with an SVC stent who develops unexplained respiratory symptoms or fever. Contrast-enhanced chest CT is essential for early detection, followed by confirmatory bronchoscopy. Management should be multidisciplinary and may include airway stenting, endovascular intervention, or surgical intervention.