First rigid bronchoscopy in COVID-19 pneumonia to treat a rare endobronchial tumor during extracorporeal membrane oxygenation

During the COVID-19 pandemic in Northern Italy, a young man with fever and dyspnea was admitted to the Emergency Department. The sudden development of severe hypoxemia and respiratory acidosis forced the emergency medical team to intubate the patient. Fiberoptic bronchoscopy and chest CT scan showed the presence of a bleeding neoformation, occluding the majority of tracheal lumen requiring the connection to a veno-venous extracorporeal respiratory support. A rigid bronchoscopy was performed to clear the tracheal lumen, obtaining a diagnosis of "composite hemangioendothelioma." All personnel involved was equipped with personal protective equipment (PPE) and power air-purifying respirators (PAPR). ECMO and mechanical ventilation were soon weaned, lung CT showed an almost complete patency of tracheobronchial tree. To the best of our knowledge, this is the first rigid bronchoscopic procedure reported in a SARS-CoV-2 virus pneumonia respiratory failure requiring ECMO, allowing to diagnose an extremely rare endobronchial tumor.