Chest
Volume 115, Issue 2, February 1999, Pages 598-600
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Selected Reports
Coronary Spasm and Cardiac Arrest From Carcinoid Crisis During Laser Bronchoscopy

https://doi.org/10.1378/chest.115.2.598Get rights and content

Bronchoscopic manipulation of an endobronchial carcinoid can precipitate a carcinoid crisis. Coronary artery spasm is an uncommon manifestation of carcinoid crisis and has never been reported as a complication of flexible bronchoscopy. We report a case of a 10-year-old girl who developed coronary artery spasm and cardiac arrest during neodymium-yttrium aluminum garnet (Nd-YAG) laser photoresection of an endobronchial carcinoid. Recognition of this unusual presentation of a carcinoid crisis is important as the treatment approach differs from standard resuscitation protocols.

Section snippets

Case Report

A 10-year-old girl presented with a 2-year history of progressive dyspnea on exercise and a recent episode of hemoptysis. She had been healthy and physically at par with her peers. She denied episodes of flushing nausea palpitations diarrhea or headaches. On exam breath sounds were diminished over the right chest and the apical impulse was displaced to the right parasternal border. The chest radiograph revealed opacification of the right hemithorax and a mediastinal shift to the same side.

Discussion

Acute carcinoid crisis can occur during FB. The carcinoid crisis usually involves the development of tachycardia flushing hypertension or hypotension.1 Coronary artery spasm is an unusual manifestation of an acute carcinoid syndrome and is not well recognized. Our patient presented with prolonged S-T segment elevation followed by ventricular tachycardia which is a characteristic of variant angina. Only two case reports have previously described coronary spasm with carcinoid syndrome.4,5 In a

Conclusion

Bronchoscopic manipulation of carcinoid tumors can cause a life-threatening carcinoid crisis. Coronary artery spasm is an uncommon presentation of the carcinoid syndrome and must be recognized by the clinician as the treatment approach to a carcinoid crisis differs from standard resuscitation protocols. Hypotension or cardiac arrest should be treated by aggressive volume replacement and intravenous somatostatin. Epinephrine should be avoided as it may paradoxically worsen the hypotension by

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