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Bronchial Catheterization with a TIPS Dilator After Failure of Conventional Technique

Ji Hoon Shin1, Ho-Young Song1, Chang Jin Yoon2, Jin Hyoung Kim1, Jin-Oh Lim1, Yong Jae Kim1 and Heung-Kyu Ko1

1 Department of Radiology, Asan Medical Center, 388-1, Poongnap-dong, Songpa-gu, Seoul, South Korea 138-736.
2 Department of Radiology, Seoul National University Hospital, Seoul, Korea.


Figure 1
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  		Fig. 1A —Devices (Flexor Check-Flo Introducer, Cook) used for bronchial catheterization. Photograph shows 0.035-inch guidewire and 9-French transjugular intrahepatic portosystemic shunt (TIPS) dilator.

 

Figure 2
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  		Fig. 1B —Devices (Flexor Check-Flo Introducer, Cook) used for bronchial catheterization. Close-up photograph shows guidewire inside TIPS dilator.

 

Figure 3
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  		Fig. 2A —40-year-old woman with tuberculous bronchial stricture. Chest radiograph shows complete collapse of left lung and deviation (arrows) of trachea to left lung.

 

Figure 4
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  		Fig. 2B —40-year-old woman with tuberculous bronchial stricture. Chest radiograph shows attempts at negotiating opening with Cobra catheter and guidewire resulted in catheter moving backward and guidewire twisting on itself.

 

Figure 5
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  		Fig. 2C —40-year-old woman with tuberculous bronchial stricture. Chest radiograph shows transjugular intrahepatic portosystemic shunt dilator (arrows) used to introduce guidewire into left main bronchus distal to stricture.

 

Figure 6
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  		Fig. 2D —40-year-old woman with tuberculous bronchial stricture. Chest radiograph shows very tight 2-cm-long stricture. Subsequent stent placement was successful (not shown).

 

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