case_images: PMC5771874_01
case_images: Chest X-ray (A) and enhanced CT (B, C) demonstrated a lung mass in the right upper lobe with hilar and mediastinal lymph nodes metastases invading the lower trachea and carina. They also showed occluded right mainstem bronchus and atelectasis of the right lung. Fiberoptic bronchoscopic images of the lower trachea after the Ultraflex covered stent placement in the right mainstem bronchus (white arrow) demonstrated a deformed and stenosed lower trachea (D). After stent placement in the lower trachea (E), the deformity ameliorated.
case_images: CCR3-6-27-g001.jpg
case_images: PMC5771874_01_CCR3-6-27-g001.jpg
case_images: ccr31278-fig-0001
case_images: He underwent chest X-ray (Fig. 1A) and enhanced CT scan (Fig. 1B and C) that demonstrated a mass in the right upper lobe with hilar and mediastinal lymph nodes metastases that invaded the lower trachea and carina. Due to the critically urgent respiratory state, Ultraflex covered stents were placed in the RMB (white arrow in Fig. 1D; 14 mm in diameter, 4 cm in length, Boston Scientific Corporation, MA) and in the lower trachea (Fig. 1E; 16 mm in diameter, 4 cm in length) on the following day.
case_images: The procedure in detail. The tumor progressed quickly and resulted in severe stenosis of the carina 2 weeks later. Furthermore, there was tumor ingrowth and overgrowth to the distal end of the lower trachea stent and the proximal end of the right mainstem bronchus stent (A). Flexible 0.035-inch guidewires were carefully inserted into the existing stent and the left mainstem bronchus (B). Bilateral Ultraflex covered stents were advanced over the guidewires to the bilateral mainstem bronchi, and the right stent was carefully released (C). After confirming full expansion, the left stent was also immediately released by adjusting the proximal end to the right counterpart that was precisely tuned by forceps (D).
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case_images: PMC5771874_01_CCR3-6-27-g002.jpg
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case_images: Therefore, bilateral Ultraflex covered stents (14 mm in diameter, 6 cm in length) were placed under topical anesthesia (Fig. 2). A fiberoptic bronchoscope was first inserted (Fig. 2A) followed by the insertion of a flexible 0.035-inch guidewire into the RMB. A similar guidewire was subsequently inserted into the left mainstem bronchus (Fig. 2B). A similar stent was immediately delivered to the LMB (Fig. 2C). The proximal end of the right counterpart was adjusted by forceps (Fig. 2D).
case_images: Images after two cycles of combination chemotherapy: chest X-ray (A), enhanced CT (B, C), and multiplanar reconstruction coronal images (D). The atelectasis of the right lung disappeared (A, D), and the bilateral stents were patent and adjacent to each other with regression of the main tumor and lymph nodes metastases (B, C). Each proximal ends was in line with each other without displacement (D).
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case_images: PMC5771874_01_CCR3-6-27-g003.jpg
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case_images: The improved performance status allowed him to undergo a combination treatment of carboplatin and paclitaxel 5 days after stenting and resulted in good partial response after two cycles of chemotherapy (Fig. 3A-D).