Abstract Introduction In the case of malignant airway obstruction, endobronchial stent placement is an effective intervention to relieve symptoms, improve quality of life, and prolong survival. However, complications still arise, and current guidelines for monitoring are supported by limited evidence. Case Presentation Presented is a 31-year-old female with Stage IV Hodgkin’s lymphoma. At the time of diagnosis, she had a large pericardial effusion, a large right-sided mediastinal mass, and an obstruction of her right mainstem bronchus. She underwent a pericardial window and bronchoscopy with endobronchial stent placement reducing obstruction from 100% to 40%. Final staging and diagnosis revealed classic Hodgkin’s lymphoma, anaplastic lymphoma kinase negative, Stage IVB, bulky disease. Mid-treatment PET-CT revealed decreased size of the mediastinal mass. Three-month surveillance bronchoscopy demonstrated appropriate position of the endobronchial stent in the right mainstem bronchus. Following completion of six cycles of brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine, post-treatment PET-CT showed continued decrease in the size and metabolic activity of the mediastinal mass. She presented to the emergency department seven months after her initial diagnosis with dyspnea. CT revealed a large right pleural effusion with completely opacified and collapsed right lung with known infiltrating mass obstructing the superior vena cava. She underwent chest tube placement and initially was placed on BiPAP. Her respiratory status deteriorated requiring intubation with bronchoscopic guidance. Bronchoscopy revealed the endobronchial stent had migrated distally to the main carina. Review of imaging revealed the endobronchial stent migrated further following chest tube placement. She was transferred to a higher level of care for Interventional Pulmonology consultation and stent removal. Endobronchial stent removed intact, and the right mainstem bronchus remained patent post-removal. Discussion Routine surveillance bronchoscopy or bronchoscopy for symptomatic patients is the current conditional recommendation with a very low certainty of evidence. One retrospective study demonstrated routine surveillance bronchoscopy detected stent complications in patients that were symptomatic. As in the case of this patient, surveillance bronchoscopy at three months demonstrated appropriate stent placement; however, she presented three months later with stent migration. Studies comparing the use of routine surveillance bronchoscopy and bronchoscopy driven by patient symptoms are needed to establish best practice guidelines and evaluate the effect each method has on quality of life. Conclusion Endobronchial stents are an effective intervention to restore patency of the airway while awaiting treatment for the underlying etiology of the obstruction. Further research is needed to determine the timing and indication of endobronchial stent monitoring. This abstract is funded by: None
Brewer et al. (Fri,) studied this question.