Stenting of the left main bronchus in cicatrical post-TB bronchial stenosis (case report)

The primary treatment of endobronchial tuberculosis complicated by bronchial stenosis is antituberculous chemotherapy. Surgical resection and bronchoplastic reconstruction has long been the standard treatment. However, bronchoscopic intervention is essential to restore the patency of the involved bronchus and controlling TB. To our best knowledge this is a first report of bronchial stenting in Georgian Republic. We performed this procedure in cooperation with interventional cardiologists from Cardiac Catheterization Laboratory "HELSY T.E." Ltd. which have wide experience in stenting manipulations. A 24-year-old woman, after treatment with antituberculous medications for pulmonary tuberculosis, suffered by cough, dyspnea, wheezing. CT scan showed stricture of the left main bronchus starting from bifurcation to the end and having a lumen diameter 2mm. Bronchoscopic examination revealed focal narrowing to pinhole size to the left main bronchus with severe fibrotic changes. We decided to perform endobronchial stenting. Under general anesthesia, balloon-expendable, metallic, non-covered stent (Medtronic) was inserted across the stenotic lesion and was expanded under the pressure of 9 atmospheres using Indeflator Perouse Medical. Bronchography, taken immediately after stent insertion, showed an expanded left main bronchus. Postoperatively the patient did well. Chest radiographs taken after 6 days demonstrating a fully expanded stent, mediastinal repositioning towards the midline and normal aeration of the left lung. Patient's dyspnea was much improved. The patient has now been asymptomatic for 3 months. In conclusion, this case describes a patient with a cicatrical post-TB bronchial stenosis that was effectively treated by bronchoscopic stenting, which is alternative to surgical resection thus avoiding unwarranted thoracotomies and providing quality of life.