case_images: PMC11119346_01
case_images: (a) Chest CT scan suggested left lung atelectasis 8 months after V-shaped silicone stent placement; (b) Left lower lung re-expansion 2 months after L-shaped silicone stent placement. (c) Left lower lung re-expansion 7 months after L-shaped silicone stent placement(coronal view). (d) Chest CT scan suggested left lung atelectasis 8 months after V-shaped silicone stent placement(horizontal view); (e) Left lower lung re-expansion 2 months after L-shaped silicone stent placement (horizontal view). (f) Left lower lung re-expansion 7 months after L-shaped silicone stent placement (horizontal view).
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case_images: However, an 8-month follow-up, including a chest CT scan [Figure 1(a) and (d)], revealed left lung atelectasis, and bronchoscopy identified the distal end of the left branch stent obstructed by granulation tissue at the bronchial opening. The bronchoscopy and CT scan were performed separately 1 week, 1 month, 2 months, 3 months, and 7 months after the operation, which showed the left lung re-expansion [Figures1(b)-(F) and Figures 2(e)-(g)], and the stent was well fixed.
case_images: Bronchoscopic view of the airway. (a) V-shaped silicone stent placement 8 months after surgery (b) V-shaped silicone stent leaded to obstruction of the bronchus by granulation tissue at the distal end (c) Balloon dilatation reopened the left lower bronchus (d) L-shaped silicone stent placement for 1 week (e) Well-fixed L-shaped stent 3 months after surgery (F) Presence of minimal granulation tissue observed at the distal end of the L-shaped stent. (G) Well-fixed L-shaped stent 7 months after surgery.
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case_images: Following the expansion of the distal opening of the left main bronchus to 12 mm, a 12 mm rigid bronchoscope was utilized to carefully extract the existing V-shaped silicone stent [Figure 2(a)-(c)]. The L-shaped silicone stent was successfully implanted into the left main bronchus, while the other branch was positioned in the trachea using a rigid bronchoscopy [Figure 2(d)]. The bronchoscopy and CT scan were performed separately 1 week, 1 month, 2 months, 3 months, and 7 months after the operation, which showed the left lung re-expansion [Figures1(b)-(F) and Figures 2(e)-(g)], and the stent was well fixed.
case_images: The process of L-shaped silicone stent. (a) The initial structure of making an L-shaped silicone stent. (b) scissored the left branch of the stent and stitched it with surgical thread. (c) The left branch of the L-shaped stent was completely stitched with surgical thread.
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case_images: We separated the right branch of the stent, which was replaced by a 25 mm x 16 mm silicone stent, sutured it to the left branch to form an L-shaped silicone stent (Figure 3).
case_images: Chest CT scan images of pre-operation and post-operation of L-shaped silicone stent placement. (a) Preoperative left lung atelectasis (coronal view). (b) Left lung re-expansion after comprehensive treatment (coronal view). (c) three months after L-shaped silicone stent placement. (coronal view). (d) Preoperative left lung atelectasis (horizontal view). (e) Left lung re-expansion after comprehensive treatment (horizontal view). (f) Three months after L-shaped silicone stent placement.
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case_images: Both a chest CT scan and bronchoscopy revealed left lung atelectasis [Figures 4(a) and (d) and Figure 5(a) and (b)]. Chest CT scans and bronchoscopies were conducted at 1 week, 1 month, 2 months, and 3 months post-operation, revealing that the L-shaped silicone stent was securely fixed without any signs of displacement [Figure 4(b)-(f) and Figure 5(j)-(l)].
case_images: Bronchoscopic view of the airway of case 2. (a) Stenosis of the left main bronchus. (b) Needle-like stenosis at the distal end of the left bronchus. (c) Placement of a metal-coated stent (d) Formation of granulation tissue caused blockage after stent placement for 3 months. (e) Recanalization through high-frequency electric knife thermal ablation. (f) Placement of a BD stent. (g) Displacement of the BD stent affecting ventilation and drainage of the left upper and lower lungs. (h) Placement of V-shaped silicone treatment. (i) The V-shaped stent deeply embedded in the carina (j) Congestion and erosion of the mucosa of the left main bronchus after removal of the V-shaped stent. (k) Placement of L-shaped stent. (l) 1 month after placement of the L-shaped stent.
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case_images: Both a chest CT scan and bronchoscopy revealed left lung atelectasis [Figures 4(a) and (d) and Figure 5(a) and (b)]. A 10 mm x 40 mm metal-coated stent was successfully implanted in the left main bronchus following balloon dilatation using a Boston Scientific 10 mm x 30 mm three-level balloon [see Figure 5(c)]. However, fibrous granulation tissue obstructed the proximal end of the stent, leading to the recurrence of left lung atelectasis [Figure 5(d)]. The left main bronchus was reopened via balloon dilation before the insertion of a 10 mm x 50 mm NOVATECH  GSS  BD silicone stent [Figure 5(e) and (f)]. Six months after the operation, it was observed that the stent had shifted toward the distal end, causing airflow obstruction in the left lung [Figure 5(g)]. With the patient's consent, the stent was removed via rigid bronchoscopy and replaced with a V-shaped silicone stent [Figure 5(h)]. Given the severe damage to the carina [Figure 5(i)], an interdisciplinary decision was made to insert an L-shaped silicone stent. Chest CT scans and bronchoscopies were conducted at 1 week, 1 month, 2 months, and 3 months post-operation, revealing that the L-shaped silicone stent was securely fixed without any signs of displacement [Figure 4(b)-(f) and Figure 5(j)-(l)].