Correct!
2. Bronchoscopy for airway secretion management
Chest CT is not unreasonable, but the patient’s renal function precluded iodinated contrast administration. Similarly, cardiac MRI typically involves the use of intravenous gadolinium administration to assess for myocardial inflammation and scar, and the administration of gadolinium-based compounds is typically avoided in patients with worsening renal insufficiency. Furthermore, echocardiography has already been successfully employed for the management of the patient’s cardiac dysfunction and inotropic support. Since chest ultrasound showed only trace left pleural effusion, thoracentesis is not required.
The progression of post-operative chest radiographic findings is shown in Figure 9.
Figure 9. Frontal chest radiograph sequence following left upper lobe resection shows progressive left lung consolidation and interlobular septal thickening.
Bronchoscopy (Figure 10) was performed and showed a normal-appearing carina with bloody secretions were noted in the left mainstem bronchus.
Figure 10. Bronchoscopy shows a normal appearing carina. Some bloody secretions were noted in the left mainstem bronchus. The left upper lobe bronchial stump appeared clean and intact. The left lower lobe bronchus was severely narrowed, described as showing a “fish-mouth” appearance with edema, through which the bronchoscope could not be advanced. The right-sided airways appeared normal.
The left upper lobe bronchial stump appeared clean and intact. The left lower lobe bronchus was severely narrowed, described as showing a “fish-mouth” appearance with edema, through which the bronchoscope could not be advanced. The right-sided airways appeared normal.
Which of the following represents an appropriate next step(s) for the patient’s management? (Click on the correct answer to be directed to the twelth of fourteen pages)