PMC9136182_01
(A) Chest radiography on admission reveals decreased permeability of the right lung. (B) Chest computed tomography (CT) on admission shows diffuse infiltrative shadows and ground-glass opacity in the right lung, and mild ground-glass opacity in the left lung. The shading is particularly severe in the right upper lobe. (C) Chest radiography on admission to the intensive care unit (ICU) reveals that the permeability has further deteriorated. (D) Chest CT on admission to the ICU shows deterioration of diffuse infiltrative shadows and ground-glass opacity in the right lung; however, aeration of the left lung is well maintained.
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Shading was particularly severe in the right upper lobe (Fig. 1A and B). She was admitted to the intensive care unit and intubated the same day due to worsening oxygenation from massive hemoptysis (Fig. 1C and D).
Bronchoscopic findings. (A) The right main bronchus is filled with blood clots. (B) Blood clot in the apical segment of the right upper lobe. (C) After removal of the blood clot, bleeding re-occurred. (D) Two EWSs were firmly inserted into the target bronchi.. EWS, Endobronchial Watanabe Spigot.
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On day 3 of ventilation, we observed the right airway through a side tube of the double-lumen tube, and the right main bronchus was filled with blood clots; however, no active bleeding was observed (Fig. 2A). Therefore, we determined the source of the bleeding to be the apical segment of the right upper lobe (Fig. 2B and C). BAE, and we could perform the treatment without losing intraoperative vision. Because a small amount of hemorrhage from the apical and the anterior segment of the right upper lobe, two 5 mm EWS in total were successfully embolized, one each in the apical and anterior segment of the right upper lobe (Fig. 2D).
(A, B) Chest radiography and computed tomography images show two EWSs in optimal positions (arrow) and the aeration of the upper right lobe was well maintained.. EWS, Endobronchial Watanabe Spigot.
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CT scan performed after extubation did not show any recurrence of lung cancer. CT also showed two EWSs in optimal positions, and the aeration of the upper right lobe was well maintained (Fig. 3).