2021 Volume 35 Issue 6 Pages 712-717
Broncho-pulmonary artery fistula is often caused by pulmonary artery inflammation due to bronchial anastomotic site leakage. Here, we report a case of broncho-pulmonary artery fistula caused by contact with a bronchial stent stud, which was placed for anastomotic site stenosis after sleeve lobectomy. A 74-year-old man underwent right upper sleeve lobectomy and mediastinal lymph node dissection for squamous cell carcinoma that had invaded his right 2nd carina. Six months later, he began to develop anastomotic site stenosis. We performed balloon dilatation 10 months after lobectomy. Since stenosis recurred after this procedure, we placed a bronchial silicone stent at the anastomotic site 11 months after the lobectomy. Eight days after placing the stent, he suffered massive hemoptysis. Because chest-enhanced computed tomography showed that a distal stent stud had pushed through the bronchial wall and was next to the right pulmonary artery, we diagnosed the patient with a broncho-pulmonary artery fistula. After intubating with a double-lumen endotracheal tube, we performed temporary unilateral occlusion of the right main pulmonary artery, which both facilitated hemostasis and helped us evaluate tolerance to pneumonectomy. We performed a completion pneumonectomy, and he was eventually discharged to home.
