An Autopsy Case of Mediastinal Lung Cancer Presenting with an Acute Massive Hemoptysis from a Broncho-aortic Fistula due to <i>Actinomyces</i> Infection of Bronchial Stent

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  • Yamamoto Aya
    Department of General Thoracic Surgery, Kansai Rosai Hospital
  • Yamasaki Haruka
    Department of General Thoracic Surgery, Kansai Rosai Hospital
  • Iwata Takashi
    Department of General Thoracic Surgery, Kansai Rosai Hospital

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  • 気管支ステント放線菌感染による気管支大動脈瘻のため喀血死した縦隔型肺癌の1剖検例

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<p>Introduction. We herein report an autopsy case of acute massive hemoptysis due to broncho-aortic fistula caused by Actinomyces infection of a bronchial self-expandable metallic stent (SEMS) in a patient with unresectable lung cancer. Case. A 64-year-old man presented with persistent cough. Chest computed tomography (CT) scan demonstrated a left hilar mass. Bronchoscopy revealed an endobronchial tumor obstructing the left main bronchus. The biopsy of the tumor revealed squamous cell carcinoma. The day after the bronchoscopy, the patient suddenly developed respiratory failure due to left total atelectasis. Thus, a SEMS was placed by a flexible bronchoscopy, as emergency treatment. Carboplatin plus S-1 was started under the diagnosis of clinical T4N1M0 stage IIIA disease. He complained of dysphagia and fever after 3 cycles of the chemotherapy. Chest CT showed esophagobronchial fistula, and another SEMS was additionally placed in the esophagus and the symptoms improved. After that, only S-1 maintenance therapy was continued to avoid further tumor necrosis. After 5 months from the diagnosis, he was transferred to our hospital for acute massive hemoptysis; however, he had suffered out-of-hospital cardiopulmonary arrest. Autopsy demonstrated broncho-aortic fistula in the left main bronchus, in which Actinomyces infection was evidenced by pathological examination.</p>

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