LUNG

A.S. Mattewal¹, H. Seethamraju², R.B. Kesavan¹, S. Bollineni^2
1Pulmonary, Critical And Care Medicine, Baylor College of Medicine, Houston/UNITED STATES OF AMERICA, ²Pulmonary And Critical Care, Methodist Hospital- Baylor college of Medicine, houston/TX/UNITED STATES OF AMERICA

Body: Airway anastamoses complications after lung transplantation are secondary to ischemia at the anastamoses site as the bronchial circulation is interrupted during implantation. We report a rare presentation of airway complication where the bronchial lumen is totally obliterated - the vanshing bronchus syndrome (VBS). We conducted a retrospective chart review of 210 lung transplant patients who are followed at the Methodist hospital- Baylor College of Medicine lung transplant program. The incidence of airway complications is 26 % and the mean time from transplant for this complication 148 days. Most common complication being bronchial stenoses, web at the anastamoses site and vanishing bronchus that required interventions. VBS occured in 3 patients. The common presentation was acute onset of shortness of breath to NYHA class 4 . Bronchoscopy earlier to the presentation did not reveal any airway abnormalities. All the 3 patients were successfully managed by flexible bronchsocopy under general anesthesia via an endotracheal tube. Initial needle puncture at the blind pouch in the airway followed by sequential dilation and eventual self expandable stents were successfully placed and the airway lumen was reestablished. Dramatic improvement in symptoms almost immediately post intervention. In two patients stents were successfully removed eventually. The VBS is seen more commonly in the bronchus intermedius than on the left bronchus.
Airway anastamoses complication post lung transplantation can be managed successfully by flexible bronchoscopy and VBS is an unique presentation of this complication. Endoscopic intervention can avoid need for pneumonectomy or lobectomy.

Disclosure: All authors have declared no conflicts of interest.