SESSION TYPE: Bronchology Global Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: A broncho-pleural fistula (BPF) is a communication between the bronchial tree and the pleural space. BPFs may occur following pulmonary resection, mechanical trauma, malignancy, necrotizing pleuropulmonary infections, or after diagnostic or therapeutic procedure of the chest region. Although persistent bronchopleural fistulas are not very common, they represent a challenging management problem and are associated with high mortality and morbidity.
CASE PRESENTATION: Four cases of persistent bronchopleural fistulae following pulmonary resection, necrotizing pneumonia, bronchioloalveolar cell carcinoma, and lymphangioliomatosis were reported. Bronchoscopic localization of BPFs were done by sequential segmental occlusion with balloon tip cather and selective bronchography. Closure of BPFs were then performed with fibrin glue instillation through double lumen catheter pass through therapeutic channel of fiberoptic bronchoscope. Thrombin and fibrinogen go simultaneously through separated channel of double lumen catheter to the fistulous tract where they met and formed fibrin glue. All BPFs were completely sealed after initial instillation. One patient with BPF from bronchioloalveolar cell carcinoma had relapsed fistula after two week of initial instillation that need further BPF occlusion successfully with cyanocrylate glues.
DISCUSSION: The treatment of BPF includes a variety of surgical and medical procedures. Recently, the advances in minimally invasive methods via interventional bronchoscopic approach yield the promised results especially in patient with limited pulmonary reserve. Sequential segmental balloon occlusion techniques is beneficial for localization of single fistulous tract and selective bronchography could confirmed in the patient who may have two or more fistulae. Injection of thrombin and fibrinogen through separated channel made more glutinous plug at fistula and less contamination through bronchoscopic therapeutic channel.
CONCLUSIONS: Flexible bronchoscopy is an effective tools for localization and management of persistent bronchopleural fistula. Sequential segmental bronchial occlusion and/or selective bronchography is practical and useful for localization of fistulae. Instillation of fibrin glue is effective method for closure of small to moderate size BPFs. This method should be considered as the initial therapeutic options for persistent BPF especially in the patient with limited pulmonary reserve.
1) Goussard, P., Gie, R., Kling, S., Kritzinger, F., van Wyk, J., Janson, J. and Andronikou, S. (2008), Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post-tuberculosis bronchiectasis. Pediatr. Pulmonol., 43: 721-725. doi: 10.1002/ppul.20843
DISCLOSURE: The following authors have nothing to disclose: Boonsong Patjanasoontorn
No Product/Research Disclosure InformationKhon Kaen University, Khon Kaen, Thailand