Segmental endobronchial valve therapy for a vasculitis-induced emphysema. (2022)

• Record Type: Journal Article
• Authors: Bal, Christina; Göschl, Lisa; Milos, Ruxandra-Iulia; Gerstbrein, Klaus; Kerschbaumer, Andreas; Idzko, Marco; Gompelmann, Daniela
• Is Part Of: Respiratory medicine case reports. Volume 37(2022)
• Publication Date: 2022
• Subjects: Vasculitis -- Emphysema -- Hypocomplementaemic urticarial vasculitis syndrome -- Valve implantation -- Segmental valve implantation; Respiratory organs -- Diseases -- Periodicals; Chest -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory System -- Periodicals; Chest -- Diseases; Respiratory organs -- Diseases; Electronic journals; Periodicals; 616.2
• DOI: 10.1016/j.rmcr.2022.101650
• Languages: English
• ISSNs: 2213-0071

Abstract

Abstract: A 53-year old female patient with history of hypocomplementaemic urticarial vasculitis syndrome (HUVS) and polyarteritis nodosa presented with progressive dyspnoea on exertion due to emphysema. Lung function revealed a severe obstructive ventilator disorder with a forced expiratory volume in 1 second of 22% of predicted, and a significant hyperinflation with a residual volume of 321% of predicted. Multi-detector computed tomography (MDCT) scan and quantitative CT analysis (StratX software) confirmed a lower lobe predominant emphysema. Considering the young age, the very severely impaired lung function, the relatively low nicotine abuse, the exclusion of alpha-1 antitrypsin deficiency, together with the known diagnosis of HUVS, the emphysema was more likely due to the vasculitis than to a typical chronic obstructive lung disease. MDCT scan showed that particularly the segment 8 of the right lower lobe was severely emphysematous destroyed and hyperinflated. Invasive Chartis® measurement revealed no significant collateral ventilation of the isolated segment 8 of the right lower lobe, so that an endobronchial valve placement was performed. Three months following intervention, the MDCT scan revealed a complete collapse of the segment 8 on the right, which was associated with a significant clinical benefit and a mild reduction of the hyperinflation in the lung function test.