Use of a Flexible Cryoprobe for Removal of Tracheobronchial Blood Clots.

Acute obstruction of the central airways can occur due to foreign-body inhalation, mucus plugs, or blood clots. Airway obstruction due to blood clots is clinically suspected in a patient with acute respiratory failure if the patient has hemoptysis. However, one third of patients with acute endobronchial obstruction due to blood clots may present without obvious hemoptysis.1,2 Management involves removal of the clot by bronchoscopic (flexible or rigid) extraction.1 During flexible bronchoscopy, clots can be removed piecemeal by biopsy forceps, dislodged using a Fogarty catheter, or removed en bloc using either suctioning or a cryoprobe.3 A cryoprobe creates very low temperatures using the Joule-Thomson effect, wherein sudden expansion of a gas from a high-pressure region to a low-pressure region results in cooling. This leads to freezing of the object or tissue. Cryotherapy has been used predominantly in the ablation of benign (granulation tissue, carcinoid, airway strictures) and malignant (bronchogenic carcinoma, salivary gland tumors of the trachea) lesions of the airways and for cryorecanalization (restoring the patency of an airway by removing a tumor). Other uses include endobronchial and transbronchial lung biopsies.4 Removal of certain foreign bodies such as tablets, food particles, and peanuts by cryoextraction has also been described.5 Herein, we report the cryoextraction of a large endobronchial blood clot using a cryoprobe during flexible bronchoscopy. Case Summary