PURPOSE: Persistent airleaks in secondary pneumothoraces can be challenging to manage, as many patients are poor surgical candidates. Endobronchial occlusion may be a promising alternative technique. However, methods of localization of bronchopleural fistulas (BPFs) remain crude.The ECVA [Chartis , Pulmonx, Inc.], consisting of an endobronchial balloon catheter and an electronic console, was developed to quantify airflow resistance through interlobar collateral channels. We postulated ECVA can also locate and quantify the severity of BPFs.
METHODS: In an airleak patient we used ECVA to measure lobar/ segmental pressures and flows. A 74 year old man with severe emphysema presented with a spontaneous right pneumothorax and persistent brisk air leak despite two attempts at chemical pleurodesis. His poor lung posed high risk for conventional surgical pleurodesis. Insertion of endobronchial valves was proposed to control the airleak. A balloon catheter introduced via the working channel of the bronchoscope was placed at the opening of the lobar bronchus, whereupon the balloon was inflated, causing temporary occlusion of the bronchus and separation of the airway distal to the occlusion from the rest of the endobronchial tree. A one-way valve was placed at the proximal end of the catheter, and airflow through the catheter system and pressure were continuously monitored at the distal end of the valve.
RESULTS: By inflating the occlusion balloon at the different lobar orifices, the right upper lobe [RUL] was identified as the location of the airleak. Isolation of the apical segment yielded significant negative pressures comparable to the pleural cavity. An assessment of the posterior segment revealed partial communication,and the anterior segment, little to none. After insertion of 3 endobronchial valves to the RUL, airleak was terminated and the drain was removed.
CONCLUSION: This case illustrates a novel application of the ECVA in the localisation and quantification of BPF which may further our understanding of the physiology of BPFs.
CLINICAL IMPLICATIONS: Accurate localisation and quantification of BPF in secondary pneumothoraces may improve the success of endobronchial occlusion treatment of BPFs.
DISCLOSURE: Michael Hsin, No Financial Disclosure Information; No Product/Research Disclosure Information