1
|
Zoumot Z, Shafiq I, Uzbeck MH, Rodriguez JH, Wahla AS. Life-threatening Bronchoperitoneal Fistula Treated With Endobronchial Valve Placement. J Bronchology Interv Pulmonol 2024; 31:e0966. [PMID: 38764167 DOI: 10.1097/lbr.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Affiliation(s)
- Zaid Zoumot
- Department of Pulmonology, Respiratory Institute
| | - Irfan Shafiq
- Department of Pulmonology, Respiratory Institute
| | | | - John H Rodriguez
- Department of General Surgery, Digestive Diseases Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Ali S Wahla
- Department of Pulmonology, Respiratory Institute
| |
Collapse
|
2
|
Damaraju V, Sehgal IS, Muthu V, Prasad KT, Dhooria S, Aggarwal AN, Agarwal R. Bronchial Valves for Persistent Air Leak: A Systematic Review and Meta-analysis. J Bronchology Interv Pulmonol 2024; 31:e0964. [PMID: 38716831 DOI: 10.1097/lbr.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/05/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND Patients with persistent air leak (PAL) pose a therapeutic challenge to physicians, with prolonged hospital stays and high morbidity. There is little evidence on the efficacy and safety of bronchial valves (BV) for PAL. METHODS We systematically searched the PubMed and Embase databases to identify studies evaluating the efficacy and safety of BV for PAL. We calculated the success rate (complete resolution of air leak or removal of intercostal chest drain after bronchial valve placement and requiring no further procedures) of BV for PAL in individual studies. We pooled the data using a random-effects model and examined the factors influencing the success rate using multivariable meta-regression. RESULTS We analyzed 28 observational studies (2472 participants). The pooled success rate of bronchial valves in PAL was 82% (95% confidence intervals, 75 to 88; 95% prediction intervals, 64 to 92). We found a higher success rate in studies using intrabronchial valves versus endobronchial valves (84% vs. 72%) and in studies with more than 50 subjects (93% vs. 77%). However, none of the factors influenced the success rate of multivariable meta-regression. The overall complication rate was 9.1% (48/527). Granulation tissue was the most common complication reported followed by valve migration or expectoration and hypoxemia. CONCLUSION Bronchial valves are an effective and safe option for treating PAL. However, the analysis is limited by the availability of only observational data.
Collapse
Affiliation(s)
- Vikram Damaraju
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Mangalagiri
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
3
|
Shorthose M, Barton E, Walker S. The contemporary management of spontaneous pneumothorax in adults. Breathe (Sheff) 2023; 19:230135. [PMID: 38229681 PMCID: PMC10790175 DOI: 10.1183/20734735.0135-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 01/18/2024] Open
Abstract
Spontaneous pneumothorax is a common presentation, and there has been a recent surge of research into the condition. With the recent publication of the new British Thoracic Society guidelines and the upcoming European Respiratory Society guidelines, we provide a concise up-to-date summary of clinical learning points. In particular we focus on the role of conservative or ambulatory management, as well as treatment options for persistent air leak and guidance for when to refer to thoracic surgeons for the prevention of the recurrence of pneumothorax. Educational aims To give up-to-date guidance on the acute management of spontaneous pneumothorax, including the role of conservative or ambulatory managementTo discuss the different treatment options for persistent air leak.To guide physicians on when to refer patients to thoracic surgeons for the prevention of the recurrence of pneumothorax.
Collapse
Affiliation(s)
| | - Eleanor Barton
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK
| | - Steven Walker
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
4
|
Adachi M, Matsumoto Y, Furuse H, Uchimura K, Imabayashi T, Yotsukura M, Yoshida Y, Nakagawa K, Igaki H, Watanabe SI, Tsuchida T. Utility of the endobronchial Watanabe spigot for intractable cancer-related pneumothorax: a retrospective observational study. Jpn J Clin Oncol 2023; 53:829-836. [PMID: 37340759 PMCID: PMC10473273 DOI: 10.1093/jjco/hyad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The use of endobronchial Watanabe spigots for intractable secondary pneumothorax in patients with cancer has not been adequate. This study aimed to investigate the use of endobronchial Watanabe spigots for intractable pneumothorax in patients with malignant tumors. METHODS Consecutive patients with malignant tumors who underwent occlusion with an endobronchial Watanabe spigot for intractable pneumothorax associated with perioperative treatment or drug therapy at our institution between January 2014 and February 2022 were reviewed. RESULTS Of the 32 cases in which an endobronchial Watanabe spigot was used, six were excluded; we thus evaluated 26 cases in which the chest tube was removed. Chest tubes were removed in 19 cases (73.1%) and could not be removed and required surgical treatment under general anesthesia in seven patients (26.9%), of which four (14.8%) underwent open-window thoracostomy. Half of the patients were treated with both an endobronchial Watanabe spigot and pleurodesis. Although thin-slice chest computed tomography revealed a fistula in 15 patients, the chest tube was removed in 11 (57.9%) patients. A significant difference was only observed in patients with a history of heavy smoking. CONCLUSIONS The chest tube removal rate was comparable to those reported in previous studies. An endobronchial Watanabe spigot may be a useful treatment option for intractable cancer-related pneumothorax.
Collapse
Affiliation(s)
- Masahiro Adachi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
- Department of Comprehensive Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hideaki Furuse
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Keigo Uchimura
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Comprehensive Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
5
|
Ficial B, Whebell S, Taylor D, Fernández-Garda R, Okiror L, Meadows CIS. Bronchoscopic Endobronchial Valve Therapy for Persistent Air Leaks in COVID-19 Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation. J Clin Med 2023; 12:jcm12041348. [PMID: 36835885 PMCID: PMC9962378 DOI: 10.3390/jcm12041348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
COVID-19 acute respiratory distress syndrome (ARDS) can be associated with extensive lung damage, pneumothorax, pneumomediastinum and, in severe cases, persistent air leaks (PALs) via bronchopleural fistulae (BPF). PALs can impede weaning from invasive ventilation or extracorporeal membrane oxygenation (ECMO). We present a series of patients requiring veno-venous ECMO for COVID-19 ARDS who underwent endobronchial valve (EBV) management of PAL. This is a single-centre retrospective observational study. Data were collated from electronic health records. Patients treated with EBV met the following criteria: ECMO for COVID-19 ARDS; the presence of BPF causing PAL; air leak refractory to conventional management preventing ECMO and ventilator weaning. Between March 2020 and March 2022, 10 out of 152 patients requiring ECMO for COVID-19 developed refractory PALs, which were successfully treated with bronchoscopic EBV placement. The mean age was 38.3 years, 60% were male, and half had no prior co-morbidities. The average duration of air leaks prior to EBV deployment was 18 days. EBV placement resulted in the immediate cessation of air leaks in all patients with no peri-procedural complications. Weaning of ECMO, successful ventilator recruitment and removal of pleural drains were subsequently possible. A total of 80% of patients survived to hospital discharge and follow-up. Two patients died from multi-organ failure unrelated to EBV use. This case series presents the feasibility of EBV placement in severe parenchymal lung disease with PAL in patients requiring ECMO for COVID-19 ARDS and its potential to expedite weaning from both ECMO and mechanical ventilation, recovery from respiratory failure and ICU/hospital discharge.
Collapse
Affiliation(s)
- Barbara Ficial
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Stephen Whebell
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
- Intensive Care Unit, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia
| | - Daniel Taylor
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Rita Fernández-Garda
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Lawrence Okiror
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Christopher I. S. Meadows
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
- Correspondence:
| |
Collapse
|
6
|
Singh H, Kurman JS, Jani C, Abdalla M, DePaul B, Benn BS. Off-label use of intrabronchial valves for persistent air leak is safe and effective: a retrospective case analysis. J Thorac Dis 2022; 14:4725-4732. [PMID: 36647468 PMCID: PMC9840033 DOI: 10.21037/jtd-22-824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
Background Persistent air leak (PAL) is a challenging clinical problem associated with prolonged hospital stay and increased morbidity. Historically, treatment options were limited to thoracostomy tube drainage, pleurodesis, and surgical repair. The development of one-way airway valves has represented a paradigm shift in PAL management. We present our experience using intrabronchial valves (IBVs) for PAL management looking at both on-label (post-thoracic surgery) and off-label (all other) indications. Methods We performed a retrospective review of our single-center experience. Data collected included demographics, primary pathology leading to PAL, comorbidities, time to chest tube removal, complications, mortality, need for any additional procedure, and time to IBV removal. Results During the study period, 15 patients underwent IBV insertion for PAL. The on-label cohort contained three patients (post lobectomy or segmentectomy). The off-label cohort had 12 patients (6 empyema, 4 secondary spontaneous pneumothorax, 1 penetrating trauma, and 1 post percutaneous lung nodule biopsy). In the on-label cohort, chest tube was removed after a mean duration of 4.0±1.0 days for all patients. In the off-label cohort, 83.3% (10/12) had chest tube removal 16.2±5.7 days (P=0.396) after IBV placement. One patient developed hypoxic respiratory failure shortly after IBV insertion, necessitating removal of 2 out of 5 valves. Conclusions IBVs are a minimally invasive, well tolerated treatment modality for patients with PAL and a viable alternative to invasive surgical interventions. Procedure or valve-related complications are uncommon. Valves can be removed and do not preclude surgical intervention. Updated guidelines are necessary to formalize PAL management.
Collapse
Affiliation(s)
- Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan S Kurman
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mohammed Abdalla
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brandon DePaul
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bryan S Benn
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
7
|
Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances. J Clin Med 2022; 11:jcm11051173. [PMID: 35268264 PMCID: PMC8911306 DOI: 10.3390/jcm11051173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 02/05/2023] Open
Abstract
Secondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. It is the commonest cause of spontaneous pneumothorax and results in significant breathlessness, higher morbidity, mortality, and longer hospital admissions than with patients with pneumothoraces and no underlying lung disease. This article explores the current guidance, controversies, and recent advances in the management of this condition.
Collapse
|
8
|
Saha BK, Bonnier A, Chong WH, Chenna P. Successful use of endobronchial valve for persistent air leak in a patient with COVID-19 and bullous emphysema. BMJ Case Rep 2021; 14:14/11/e246671. [PMID: 34799393 PMCID: PMC8606771 DOI: 10.1136/bcr-2021-246671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5-7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.
Collapse
Affiliation(s)
- Biplab K Saha
- Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA
| | - Alyssa Bonnier
- Department of Nursing, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri, USA
| | - Woon Hean Chong
- Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York, USA
| | - Praveen Chenna
- Pulmonary and Critical Care Medicine, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| |
Collapse
|
9
|
Kurman JS. Persistent air leak management in critically ill patients. J Thorac Dis 2021; 13:5223-5231. [PMID: 34527361 PMCID: PMC8411173 DOI: 10.21037/jtd-2021-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022]
Abstract
Persistent air leak (PAL) is a challenging clinical entity, particularly in the setting of critical illness. It is a significant cause of morbidity, health care expenditure, and resource utilization. Data on its prevalence in the critically ill patient population are limited. Unique patient factors often necessitate an individualized approach. Guidelines on this subject are antiquated and do not specially address patients on mechanical ventilation. Critically ill patients may not be able to tolerate surgical intervention. Treatment in this population relies upon lung protective ventilation, various anecdotal modalities, chemical pleurodesis, autologous blood patching, and bronchoscopic insertion of endobronchial valves. Ventilation strategies center on rapid weaning and reduction of airway pressures. Anecdotal methods include implantable devices and chemical agents. Data on these modalities are limited to case reports. None have United States Food and Drug Administration (FDA) approval. The Spiration Valve System is FDA approved as a Humanitarian Device Exemption. Data on endobronchial valves are based on large case series, and only one small case series has focused exclusively on critically ill patients. The majority of valves in critically ill mechanically ventilated patients are used for non-FDA approved indications. Updated guidelines are desperately needed to ensure a standardized approach to this common clinical situation.
Collapse
Affiliation(s)
- Jonathan S Kurman
- Division of Pulmonary & Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
10
|
Valentin R, Patel DC, Jantz MA, Mehta HJ, Mehrad B, Gomez Manjarres DC. The Role of Bronchoscopic Interventions in the Management of Pneumothorax in Interstitial Lung Disease. J Bronchology Interv Pulmonol 2021; 28:238-240. [PMID: 33208606 PMCID: PMC8191571 DOI: 10.1097/lbr.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ramon Valentin
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL
| | | | | | | | | | | |
Collapse
|
11
|
Mingora CM, Flume PA. Pulmonary Complications in Cystic Fibrosis: Past, Present, and Future. Chest 2021; 160:1232-1240. [PMID: 34147501 DOI: 10.1016/j.chest.2021.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic condition with multisystemic disease manifestations, the most prominent of which occur in the respiratory system. Despite significant developments in disease understanding and therapeutics, each contributing to improved lung function and survival in patients with CF, several pulmonary complications, including pneumothorax, massive hemoptysis, and respiratory failure, continue to occur. In this review, we briefly describe each of these complications and their management and discuss how they impact the care and disease trajectory of individuals in whom they occur. Finally, we discuss the evolving role that palliative care and CF transmembrane conductance regular modulator therapies play in the natural disease course and care of patients with CF.
Collapse
Affiliation(s)
- Christina M Mingora
- Department of Medicine, Medical University of South Carolina, Charleston, SC.
| | - Patrick A Flume
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
12
|
Holtzclaw A, McKay S, Mullenix P, Browning R. Novel Treatment of a Refractory Alveolopleural Fistula Using Medical Pleuroscopy. J Bronchology Interv Pulmonol 2021; 28:e4-e7. [PMID: 33332848 PMCID: PMC7217123 DOI: 10.1097/lbr.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Phillip Mullenix
- Department of Cardiothoracic Surgery Walter Reed National Military Medical Center, Bethesda, MD
| | | |
Collapse
|
13
|
Surgically intractable bronchopleural fistula treated with endobronchial valve insertion by isolating the tract with indigo carmine: A case report. Respir Med Case Rep 2019; 29:100972. [PMID: 31871886 PMCID: PMC6909222 DOI: 10.1016/j.rmcr.2019.100972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/03/2022] Open
Abstract
Bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. Herein, we report a patient with persistent air leak after necrotizing pneumonia, where tract of BPF was not apparent in computed tomography (CT). Despite control of infection, watchful observation, repetitive procedures, and surgery, air leak was not resolved. This led to consideration of the endobronchial valve (EBV) placement. After identifying the bronchial segment leading to the fistula with indigo carmine, precise occlusion of the lingular division of the left upper lobe (LUL) was performed using an EBV. Subsequently, the air leak was resolved. During 6 months of follow-up, neither recurrence of BPF nor any procedure-related complications were noted. We concluded that precise EBV placement by identifying bronchial segment leading to the BPF, could be an effective treatment for persistent air leak.
Collapse
|