PURPOSE: Standard treatment of persistent symptomatic bronchopleural fistulas (BPF) following pneumonectomy involves thoracotomy with primary closure and transposition of a vascularized muscle flap to the bronchial leak. Because this major operation may be ineffective or contraindicated in certain patients, alternate innovative techniques are necessary.
METHODS: We successfully treated a patient with recurrent BPF using a 16mm Amplatzer plug reinforced with transthoracic injection of n-butyl cyanoacrylate (nBCA) glue under CT guidance and a Dumon stent modified as an elbow shape to fit the left mainstem bronchus and distal trachea yet seal the right mainstem stump. The stent was inserted through a rigid bronchoscope under direct vision with position confirmed by fluoroscopy. Post-operatively, bronchoscopy confirmed the stent was well anchored and patent. The patient was discharged two days after the surgery.
RESULTS: On post-op day 36, the patient presented to the ER complaining of gagging, coughing and gasping. No wheezing was noted on auscultation. A chest x-ray showed the Dumon stent was displaced directly below cords. The patient was taken to the OR and using rigid bronchoscopy and grasping forceps the stent was removed en masse with the bronchoscope. There was no evidence of cord injury on inspection following removal. Follow-up Xenon ventilation scan showed no evidence of BPF and the patient remains asymptomatic.
CONCLUSION: We conclude transthoracic injection under CT guidance reinforced with a Modified Dumon stent may allow non-operative management of post-pneumonectomy BPF.
CLINICAL IMPLICATIONS: This alternative technique may be used when thoracotomy with primary closure and transposition of vascularized muscle flap is unsuccessful or contraindicated in patients with BPF.
DISCLOSURE: Sarah Dunn, None.