CHEST Guidelines-Bronchiectasis-Complicating-Lung-Volume-Reduction-

Bronchiectasis-Complicating-Lung-Volume-Reduction-

Pdf Summary

Endoscopic lung volume reduction (LVR) is a technique used to enhance lung function in patients with emphysema. While promising, it can lead to complications, such as bronchiectasis, which had not been documented until now. This report details the case of a 51-year-old former smoker with emphysema who underwent LVR coil treatment in 2013. Initially, he showed mild improvements; however, at 18 months post-procedure, his respiratory condition worsened, necessitating consideration for lung transplantation.<br /><br />Upon evaluation for transplantation, a CT scan revealed bronchiectasis at the sites of coil insertion, predominantly in the left lower lobe but also in the right upper lobe. Such a finding wasn’t present before the coil insertion and was minimal six months after the procedure. The bronchiectasis did not cause frequent infections, nor did it lead to daily sputum production.<br /><br />The report highlights the LVR coil procedure’s potential complications, which include COPD exacerbation, hemoptysis, pneumothorax, and pneumonia. The development of bronchiectasis might be due to the reaction of the bronchus wall to the coil, airway closure, local ischemia from arterial kinking, or tension-induced inflammation. The authors suggest that such complications warrant careful investigation and monitoring, especially to understand the long-term implications.<br /><br />The study underscores the need to avoid placing multiple coils in the same subsegment to reduce the risk of developing bronchiectasis. This finding, though asymptomatic in the case presented, raises concerns about potential long-term structural changes in the lungs following coil insertion, necessitating further research to determine the prevalence and clinical significance of this complication.

Keywords

endoscopic lung volume reduction

emphysema

bronchiectasis

LVR coil treatment

lung transplantation

complications

CT scan

COPD exacerbation

long-term implications

structural changes