Bilateral concurrent massive hemoptysis successfully controlled with double endobronchial tamponade. A case report.

Massive hemoptysis is a potentially lethal situation for which emergency diagnosis and treatment are necessary. Endobronchial tamponade is widely used as a method for conservative management of massive hemoptysis by occluding the bleeding bronchus with a balloon catheter. Some balloon catheters can be introduced through the inner channel of a flexible bronchoscope. The main challenge in performing this procedure is how to remove the bronchoscope without displacing the catheter. Another technique is to place a catheter next to the fiberoptic bronchoscope and then advance the catheter to the hemorrhaging bronchial division. An advantage of this ''parallel technique'' is that the working channel is available for suction, lavage and for a biopsy forceps, that can be used to facilitate the positioning of the catheter. We used this technique to perform bilateral endobronchial tamponade with two 5 Fr Swan-Ganz catheters. This case shows that bilateral concurrent massive hemoptysis can be successfully controlled with the placement of more than one balloon catheter. This is a rare event and in the literature we found only one reference. The procedure was relatively easy to perform and well tolerated by the patient. In our opinion, this technique should be considered as a viable option in the treatment of massive hemoptysis especially in hospitals or patients where other treatments are impossible or contraindicated.

Tracheomalacia associated with Mounier-Kuhn syndrome in the Intensive Care Unit: treatment with Freitag stent. A case report.

Tracheomalacia is a process characterized by softness of the supporting tracheal cartilages, by the extension of the posterior membranous wall and by reduction of the tracheal antero-posterior diameter. Exceptionally, tracheomalacia can be associated with tracheobronchomegaly or Mounier-Kuhn syndrome. Fibro-bronchoscopy represents the ''gold standard'' for diagnosis. The case of a 79-year-old male observed after hospitalization in a medical ward for chronic pulmonary obstructive disease (COPD) decompensation, and with basal left bronchopulmonary focus, is described. During this period, a progressive worsening of clinical conditions occurred, despite cortisone and antibiotic therapy, and the patient was transferred to the ICU for dyspnea, hypoxia, hypocapnia and with a diagnosis of pulmonary fibrosis. Bronchoscopy, performed during spontaneous breathing, revealed tracheomalacia which was responsible for tracheal dynamic complete stenosis during expiration and dynamic subtotal stenosis of the left primary bronchus in the first tract, together with sputum retention. Moreover, this investigation confirmed the diagnosis of tracheobronchomegaly already seen on CT. It was suggested to place a Freitag stent, since the insertion of another model would not have had enough chance of stability, due to the enormous extension of the tracheal lumen and could not have guaranteed good clearance of the secretions. Seven days after this intervention, performed in an outpatients' setting, the patient was dismissed from the ICU, without the help of O2, with good ventilation, saturation in line with his age and good expectoration.