Self-expanding metallic stent resulting in lung abscess

Purpose: We report our experience in treating a complication from placement of a self-expanding metallic stent (SEMS) in the airway. Background: SEMS are placed with increasing frequency to relieve airway obstruction. Because they may be placed with the aid of flexible bronchoscopy with or without fluoroscopy, many pulmonologists have acquired training through postgraduate courses to place them. Complications from SEMS placement are seen commonly in centers with expertise in treating central airway obstruction. Case Description: A 62-year-old man with recurrent bronchitis and pneumonia was evaluated by a pulmonologist in a community hospital setting. Bronchoscopy was performed to investigate the etiology of recurrent infiltrates in the right middle lobe. Narrowing of the right middle lobe orifice was discovered and treated with SEMS placement. Five days later, the patient developed fever, pleuritic chest pain, and a productive cough. He was referred to our institution where the stent was found to have migrated into a subsegment of the right middle lobe. Pneumonia was present in the right middle and lower lobes complicated by a parapneumonic effusion. He underwent thoracotomy for right middle lobe lobectomy 9 days after SEMS placement. A right middle lobe lung abscess associated with the SEMS was discovered during the operation. The patient recovered uneventfully. Conclusions: SEMS placement resulted in distal migration of a right middle lobe stent. The patient rapidly developed pneumonia, lung abscess, and a parapneumonic effusion requiring thoracotomy. This is the first report to describe distal migration causing lung abscess from SEMS placement.