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Research ArticleFocus on Transplantation

Vanishing Bronchus After Lung Transplantation: The Role of Sequential Airway Dilatations

Abdul Hamid Alraiyes, Hanine Inaty and Michael S. Machuzak
Ochsner Journal March 2017, 17 (1) 71-75; DOI: https://doi.org/10.1043/1524-5012-17.1.71
Abdul Hamid Alraiyes
1Interventional Pulmonology, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
2Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY
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Hanine Inaty
3Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
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Michael S. Machuzak
3Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
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    Figure 1.

    Significant ischemic mucosal necrosis was observed distal to the anastomosis bilaterally in the left main stem (A) and right main stem (B). (A color version of this photograph is available online at www.ochsnerjournal.org/toc/ochs/17/1 in the Focus on Transplantation section.)

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    Figure 2.

    A. Bronchoscopic view of intact right main stem anastomosis with significant distal mucosal necrosis. B. Ischemic mucosal necrosis with thick overlying debris at the level of the right upper lobe. C. Mucosal ischemia extending distally at the level of the bronchus intermedius, the right middle lobe, and the right lower lobe segments. (A color version of this photograph is available online at www.ochsnerjournal.org/toc/ochs/17/1 in the Focus on Transplantation section.)

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    Figure 3.

    Transballoon bronchoscopic view of the right middle lobe with sequential CRE balloon dilation at 1 atm (A) and 3 atm (B) shows improvement in the lumen size with no evidence of airway tear. CRE, controlled radial expansion. (A color version of this photograph is available online at www.ochsnerjournal.org/toc/ochs/17/1 in the Focus on Transplantation section.)

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    Figure 4.

    A. Bronchoscopic view of a well-healed right main stem anastomosis at 3 months posttransplant with significant improvement in distal mucosal necrosis. B. Right upper lobe segments at 3 months posttransplant show significant improvement of mucosal ischemia and patent airway lumen with mild stenosis. C. Bronchus intermedius at 3 months posttransplant with patent right lower lobe airways after iCAST stent (7 × 16 mm) deployment in the right middle lobe. (A color version of this photograph is available online at www.ochsnerjournal.org/toc/ochs/17/1 in the Focus on Transplantation section.)

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    Figure 5.

    Risk factors that promoted airway necrosis and stenosis post–lung transplant in this case.

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    Table.

    Airway Mucosal Necrosis Grading Scale

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Vol. 17, Issue 1
Mar 2017
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Vanishing Bronchus After Lung Transplantation: The Role of Sequential Airway Dilatations
Abdul Hamid Alraiyes, Hanine Inaty, Michael S. Machuzak
Ochsner Journal Mar 2017, 17 (1) 71-75; DOI: 10.1043/1524-5012-17.1.71

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Vanishing Bronchus After Lung Transplantation: The Role of Sequential Airway Dilatations
Abdul Hamid Alraiyes, Hanine Inaty, Michael S. Machuzak
Ochsner Journal Mar 2017, 17 (1) 71-75; DOI: 10.1043/1524-5012-17.1.71
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Keywords

  • Airway management
  • Bronchi
  • lung transplantation
  • necrosis

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