REGULAR CONTENT
Final ID
593
Type
Educational Exhibit-Poster Only
Authors
S Rambhia1, M Gould2, D Caplin1
Institutions
1North Shore University Hospital, Northwell Health, Manhasset, NY, 2Hofstra Northwell School of Medicine, Hempstead, NY
Purpose
1) To discuss the pathophysiology and management of refractory hypoxemia in the setting of advanced lung neoplasm.2) To discuss the concept of V-Q mismatch as a source of refractory hypoxemia and to present a case of a malignancy related V-Q mismatch in a terminally ill patient, which was treated via selective pulmonary artery embolization, improving ventilation.3) To describe how pulmonary artery embolization can be integrated in the management algorithm of refractory hypoxemia in end stage lung cancer.
Materials & Methods
Dyspnea is a critical issue in terminally ill cancer patients. 55.7% of patients with terminally ill cancer involving the lung experience dyspnea [1, 2]. The concept of refractory hypoxemia due to massive intrapulmonary shunting has been described previously [3]. Redirecting pulmonary vascular flow to restore V-Q match has been reported in a single case report of a patient with refractory hypoxemia due to large invasive mucinous adenocarcinoma of the lung with a positive outcome [4].
Results
In this exhibit, we present a case of an elderly male with unilateral endobronchial neoplastic disease of the right lung resulting in progressively worsening hypoxemia that required high percentage oxygen supplementation, likely from large V-Q mismatch. Right main pulmonary artery balloon occlusion resulted in increased arterial oxygen saturation from range of 80-85% to 90-95% while on 100% non-rebreather facemask. Subsequent embolization of four basilar branches of the right lower lobe pulmonary artery with a combination of microcoils and 40%-cyanoacrylate (n-BCA) resulted in immediate transition from non-rebreather mask to nasal cannula.The role of pulmonary artery embolization will be discussed in the larger frame of current clinical management of refractory hypoxemia in lung cancer with reference to our institutional experience as well as published literature.
Conclusions
We present a novel use for treating V-Q mismatch in a patient with refractory hypoxemia from lung malignancy. Further literature review and clinical studies and may be beneficial to see how pulmonary artery embolization may be included in algorithms for palliative management of refractory hypoxemia.
Final ID
593
Type
Educational Exhibit-Poster Only
Authors
S Rambhia1, M Gould2, D Caplin1
Institutions
1North Shore University Hospital, Northwell Health, Manhasset, NY, 2Hofstra Northwell School of Medicine, Hempstead, NY
Purpose
1) To discuss the pathophysiology and management of refractory hypoxemia in the setting of advanced lung neoplasm.2) To discuss the concept of V-Q mismatch as a source of refractory hypoxemia and to present a case of a malignancy related V-Q mismatch in a terminally ill patient, which was treated via selective pulmonary artery embolization, improving ventilation.3) To describe how pulmonary artery embolization can be integrated in the management algorithm of refractory hypoxemia in end stage lung cancer.
Materials & Methods
Dyspnea is a critical issue in terminally ill cancer patients. 55.7% of patients with terminally ill cancer involving the lung experience dyspnea [1, 2]. The concept of refractory hypoxemia due to massive intrapulmonary shunting has been described previously [3]. Redirecting pulmonary vascular flow to restore V-Q match has been reported in a single case report of a patient with refractory hypoxemia due to large invasive mucinous adenocarcinoma of the lung with a positive outcome [4].
Results
In this exhibit, we present a case of an elderly male with unilateral endobronchial neoplastic disease of the right lung resulting in progressively worsening hypoxemia that required high percentage oxygen supplementation, likely from large V-Q mismatch. Right main pulmonary artery balloon occlusion resulted in increased arterial oxygen saturation from range of 80-85% to 90-95% while on 100% non-rebreather facemask. Subsequent embolization of four basilar branches of the right lower lobe pulmonary artery with a combination of microcoils and 40%-cyanoacrylate (n-BCA) resulted in immediate transition from non-rebreather mask to nasal cannula.The role of pulmonary artery embolization will be discussed in the larger frame of current clinical management of refractory hypoxemia in lung cancer with reference to our institutional experience as well as published literature.
Conclusions
We present a novel use for treating V-Q mismatch in a patient with refractory hypoxemia from lung malignancy. Further literature review and clinical studies and may be beneficial to see how pulmonary artery embolization may be included in algorithms for palliative management of refractory hypoxemia.