학술논문
Use of 3-D navigation to target the site of autologous blood installation for lung volume reduction in bullous emphysema.
Document Type
Academic Journal
Author
Hetzel J; Department of Medical Oncology and Pneumology, University Hospital of Tuebingen, Tuebingen, Germany.; Boeckeler M; Department of Medical Oncology and Pneumology, University Hospital of Tuebingen, Tuebingen, Germany.; Lewis RA; NPARU, University of Worcester, Worcester, UK.; Horger M; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany.; Haentschel M; Department of Medical Oncology and Pneumology, University Hospital of Tuebingen, Tuebingen, Germany.
Source
Publisher: SAGE Publications Country of Publication: England NLM ID: 101197408 Publication Model: Print Cited Medium: Internet ISSN: 1479-9731 (Electronic) Linking ISSN: 14799723 NLM ISO Abbreviation: Chron Respir Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Bronchoscopic lung volume reduction (BLVR) using intrabullous autologous blood instillation has been reported in single cases where other techniques are not possible. We present the use of three-dimensional navigation to instill autologous blood into emphysematous bullae for BLVR. A 62-year-old man presented with increasing dyspnea, due to emphysema with a conglomerate of giant bullae with two particularly large bullae. Surgical treatment was refused, so bronchoscopic autologous blood instillation into the bronchial segment leading to the large bullae was attempted, but was unsuccessful; blood failed to penetrate into the bullous cavity. Dyspnea worsened over the following year. We therefore performed another bronchoscopy and punctured a large bulla with a needle and created a tunnel from the central airways. Puncture position and direction were determined using a prototype of an electromagnetic navigation system. Under fluoroscopic guidance, a catheter was placed via the tunnel into the bulla and blood was instilled. This resulted in an almost complete shrinkage of the bullae, reduction of residual volume, and marked improvement in dyspnea within 4 months. To our knowledge, this is the first reported case of successful BLVR by navigated bronchoscopy with transbronchial puncture, dilatation, and autologous blood instillation into a giant bulla.