A 29-year-old woman had had left pleuritic chest pain and dyspnea for 6 months. Eight years earlier, she had taken antituberculous medication for pulmonary tuberculosis.
Three years earlier, bronchoscopic examination revealed focal narrowing of the left main bronchus with severe fibrotic changes suggestive of sequelae of endobronchial tuberculosis. She was treated with balloon dilatation. But her symptoms increased over the next 2 months, and it was believed that further treatment was needed for her stenosis.
Therefore, she was successfully treated with Gianturco self-expandable metallic stents. After the procedure, her clinical symptoms were improved. However, 30 months after stent placement, dyspnea on exertion developed and we noted obstruction at the site of the metallic stent by bronchoscopic examination.
On physical examination, respiratory sound was absent on the side of the chest.
Chest X-ray showed total collapse of the left lung (Fig. 2B). Bronchoscopic examination revealed total obstruction of left main bronchus with granuloma-appeared polypoid mass and proximal portion of migrated metallic stents (Fig. 3). Pulmonary function tests showed the forced expiratory volume in 1s (FEV1) of 0.74L(26% of predicted), FEV1/FVC 50%, the forced vital capacity (FVC) for 1.48L (41% of predicted).
Resection of the left lung, inclunding the stenotic segments of the left bronchus, was performed.
After operation, her pulmonary function tests shows FEV1, of 1.32L (48% of predicted), FEV1/FVC 68%, FVC for 1.80L (50% of predicted). In resected specimen, soft-palpated mass was detected with metallic stent in obstructed bronchus. Biopsy finding of left main bronchus shows granulomatous inflammation by foreign body reaction which is composed of epithelioid cells and lymphocyte.
At 6 months after the operation, the patient was clinically well.