Evaluating bronchial anastomotic stenosis dynamically by electrical impedance tomography in a lung transplant recipient: a case report

BACKGROUND: Lung transplantation has become the first-choice treatment method for end-stage pulmonary disease patients. However, various postoperative airway complications hinder the progress of lung transplantation, with the most frequently reported complication being bronchial stenosis. Pendelluft is an intrapulmonary air redistribution in areas with different time constants and this phenomenon is largely unobservable. Meanwhile, pendelluft is the movement of gas in the lung without a change in tidal volume and can contribute to injury by introducing regional overdistension and tidal recruitment. Electrical impedance tomography (EIT) is a radiation-free and noninvasive imaging tool that can be used to evaluate pulmonary ventilation and perfusion. EIT is also a novel imaging technique that allows real-time detection of pendelluft. CASE DESCRIPTION: A single lung transplant recipient had bronchial anastomotic stenosis caused by necrosis. The patient was admitted to the intensive care unit for the second time due to worsening oxygenation. We evaluated the patient’s pulmonary ventilation and perfusion and pendelluft effect dynamically by EIT. The saline bolus injection method was used to evaluate pulmonary perfusion distribution. We removed the bronchial anastomosis necrosis using bronchoscopy biopsy forceps. The ventilation/perfusion (V/Q) matching in the transplanted lung improved compared to that before necrosis removal. After necrosis removal, the global pendelluft in the lung transplant recipient improved. CONCLUSIONS: EIT can be used to quantitatively evaluate the pendelluft and V/Q matching due to bronchial stenosis in lung transplantation. This case also demonstrated the potential of EIT as a dynamic pulmonary functional imaging tool for lung transplantation.