ABSTRACT
We report a rare case of a patient experiencing persistent exertional dyspnoea due to a subacute, adhesive and immobile airway blood clot following haemoptysis. Cryoextraction with short freezing times, which fragmented the clot into small pieces, proved effective, despite previous reports on acute airway blood clots recommending longer freezing times.
Keywords: airway obstruction, blood clot, bronchoscopy, cryoprobe
This report is the first demonstration of the cryoextraction of subacute airway blood clots.
1. Clinical Image
A 68‐year‐old non‐intubated male patient who had undergone successful bronchial artery embolization for massive haemoptysis developed persistent exertional dyspnoea following haemostasis, without associated desaturation. Computed tomography revealed a large blood clot in the right middle bronchial trunk that had not been expectorated by the patient for 2 weeks (Figure 1), prompting the decision to perform cryoextraction. Despite freezing for ≥ 5 s to remove it as a large piece, the clot remained immobile. Shortening the freezing time to 3–4 s allowed extraction of a small piece of the clot. Although the clot occasionally fragmented within the endotracheal tube, the small pieces were suctioned easily. The entire clot was removed by repeated short‐duration freezing, resulting in the resolution of dyspnoea (Figure 2 and Video 1). There had been no recurrence of bleeding or dyspnoea post‐cryoextraction at the time of this report (at least 6 months).
FIGURE 1.
(A1–A3) Computed tomography (CT) taken the day before the bronchial artery embolization (BAE) showed finding suggestive of a blood clot in the right middle bronchial trunk (red arrows). (B1–B3) CT performed 2 weeks after the BAE showed the residual airway blood clot (green arrows). (C1–C3) A 3‐month follow‐up CT showed the complete resolution of the clot (white arrows).
FIGURE 2.
(A) Right main bronchus: the subacute blood clot covered the right second carina and obstructed the right middle bronchial trunk. (B, C) We removed the subacute, adhesive, and immobile clot with short freezing time, breaking it into small pieces. (D) The entire clot was removed by repeated short‐duration freezing.
VIDEO 1.
Cryoextraction of subacute airway blood clot. Video content can be viewed at https://onlinelibrary.wiley.com/doi/10.1002/rcr2.70155
This report is the first demonstration of the cryoextraction of subacute airway blood clots. Previous studies on cryoextraction for acute, life‐threatening airway blood clots highlighted the removal of clots as a single large piece using longer freezing times (15–120 s) [1, 2]. However, our non‐emergent case, 2 weeks post‐haemostasis, revealed that the time‐formed clot was adhesive and immobile, and that it could not be removed by long‐duration freezing. Furthermore, shortening the freezing time to fragment the clot should reduce the risk of mucosal damage and uncontrollable tube obstruction.
Author Contributions
Takashi Nishihara drafted the initial manuscript and prepared the images. All authors revised the manuscript and approved the final version of the manuscript.
Ethics Statement
The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
The authors thank Dr. Takehiko Kobayashi and Dr. Misaki Ryuge (NHO Kinki Chuo Chest Medical Center) for their help with performing bronchoscopy.
Associate Editor: Yuanlin Song
Funding: The authors received no specific funding for this work.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
- 1. Sriratanaviriyakul N., Lam F., Morrissey B. M., Stollenwerk N., Schivo M., and Yoneda K. Y., “Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non‐Neoplasm Tracheobronchial Obstruction: A Retrospective Chart Review,” Journal of Bronchology & Interventional Pulmonology 22, no. 4 (2015): 288–293. [DOI] [PubMed] [Google Scholar]
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.