Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea.
Medicina (Kaunas). 2022 Feb 2;58(2):231. doi: 10.3390/medicina58020231.
Airway compression is a rare complication of esophageal stent placement. With the introduction of self-expanding metal stents, the incidence of bronchial obstruction by esophageal stents has decreased. Delayed external airway compression after esophageal stent implantation is rarely reported. We describe a case of left main bronchial obstruction after self-expandable esophageal stent placement. A 70-year-old patient with advanced esophageal cancer visited the emergency room (ER) with worsening cough and dyspnea. He had received palliative concurrent chemoradiotherapy after esophageal self-expanding metal stent (SEMS) insertion three months ago. One month before the ER visit, additional esophageal SEMS placement (stent-in-stent) was performed owing to the development of a tracheoesophageal fistula. After hospitalization, chest radiography revealed a patchy consolidation in the left lower lobe. A diagnosis of pneumonia was made, and the patient was treated with antibiotics. Seven days after antibiotic treatment, the patient developed a fever and severe dyspnea. Auscultation revealed the absence of breath sounds in the left hemithorax. A follow-up chest radiograph showed a white-out of the left hemithorax. Flexible bronchoscopy revealed luminal narrowing of the left main bronchus (LMB) due to external compression. Chest computed tomography further demonstrated compression of the LMB by esophageal stents. This case highlights that esophageal SEMS can present as an emergent and often life-threatening airway obstruction.
气道压迫是食管支架置入的罕见并发症。随着自膨式金属支架的引入，食管支架引起的支气管阻塞发生率有所下降。食管支架植入后发生迟发性外源性气道压迫的情况很少见报道。我们描述了一例自膨式食管支架置入后发生左主支气管阻塞的病例。一名 70 岁的晚期食管癌患者因咳嗽和呼吸困难加重而到急诊科就诊。他在三个月前接受了食管自膨式金属支架（SEMS）置入的姑息性同步放化疗。在急诊科就诊前一个月，由于发生气管食管瘘，进行了额外的食管 SEMS 置入（支架内支架）。住院后，胸部 X 线片显示左下肺斑片状实变。诊断为肺炎，并给予抗生素治疗。抗生素治疗 7 天后，患者出现发热和严重呼吸困难。听诊发现左胸腔无呼吸音。复查胸部 X 线片显示左半胸腔一片白。软性支气管镜检查显示左主支气管（LMB）腔内狭窄，系外部压迫所致。胸部计算机断层扫描进一步显示食管支架压迫 LMB。本例提示食管 SEMS 可表现为紧急且常危及生命的气道阻塞。
