PMC8473540_01
Lung mass right upper lobe with PET-CT.
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fig1
The patient had a right paratracheal mass diagnosed with EBUS-TBNA 22G (Fig. 1, Fig. 2.).
Blue arrows indicate the fistulas. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Bronchoscopy reveled two minor fistulas in the interior wall of the trachea (Fig. 3.).
Schematic demonstration for the muscle flap placement.
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fig4
An additional surgery was performed in order to add a muscle flap patch on the exterior part of the trachea (Fig. 4.).
Left; silicon stent number 14-diameter- 6cm-length, Middle; images from the silicon stent placement, Right; Patient intubated with STORZ rigid bronchoscope number 14mm-(outer rim, 13mm inner working channel). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Unfortunately additional stent placement was placed after a silicon stent since the muscle patches failed (Fig. 5.).
Images from the mettalic stent placement procedure.
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fig6
We chose finally a metallic auto expandable stent since after three months of follow up a small metastatic lesion was observed in the liver (Fig. 6, Fig. 7.).
Left: up and down image the Jet-Ventilator twin stream model that we used. Right: Up and down the rigid bronchoscope number 12mm with inner rim 11mm (working channel) with the necessary jet-ventilator connector and light. Moreover; a rigid electrocautery probe with suction capability.
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fig8
The patient had a biopsy of the initial metastatic liver lesion and with PD-L1 expression 90% is under immunotherapy with pembrolisumab for 9 months with complete disease control (see Fig. 8).