SESSION TYPE: Bronchology Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Secondary spontaneous pneumothorax (SSP) occurs as a result of pre-existing lung disease . While chronic obstructive pulmonary disease is more common, fibrocystic sarcoidosis may lead to SSP and pose difficult management challenges . An air leak that persists at seven days despite thoracostomy tube evacuation is classified as prolonged, and more aggressive approaches must be considered including video assisted thoracoscopy (VATS) pleurodesis and/or stapling of the air leak source. Alternatively, patients receive prolonged inpatient thoracostomy drainage, which adds significant health care costs and predisposes patients to complications. For patients who are not candidates for invasive procedures, endobronchial valve placement is an emerging option. Currently, one endobronchial valve has received a humanitarian device exclusion (HDE) to treat the rare condition of prolonged air leaks following lobectomy, segmentectomy, or lung volume reduction surgery. Use for prolonged air leaks in patients with lung diseases other than emphysema has been the subject of case reports. We report 2 cases in which EBV were used to treat prolonged SSP.
CASE PRESENTATION: Case 1: A 56-year-old female with stage 4 sarcoidosis, dyspnea, and a right pneumothorax had a chest tube placed followed by VATS talc pleurodesis. The air leak persisted and endobronchial valve placement was performed with immediate resolution of the air leak. Case 2: A 34-year-old male with stage 4 sarcoidosis presented with dyspnea and a large left basilar pneumothorax. Chest tube placement and blood patch pleurodesis failed to resolve the pneumothorax. Four endobronchial valves were placed in the left upper lobe and lingula with slowing but not resolution of the air leak. The patient then underwent VATS, which had to be converted to a left upper lobectomy.
DISCUSSION: Endobronchial valves are a novel treatment option for prolonged air leaks due to pneumothorax; however, the recommendations for its use outside of post-surgical air leaks are unclear. These 2 cases demonstrate success and failure of this intervention in patients who are not post-surgical and do not have emphysema.
CONCLUSIONS: Further studies are needed before this procedure becomes standard of care, and for now it should be considered in carefully selected patients under the category of compassionate use.
1) Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000; 342: 868.
2) Wait MA, Estrera A. Changing clinical spectrum of spontaneous pneumothorax. Am J Surg 1992; 164: 528.
DISCLOSURE: The following authors have nothing to disclose: Travis Greer, Nicholas Pastis, Charlie Strange, John Huggins
The use of endobronchial valves is not yet FDA approved for treatment of persistent secondary spontaneous pneumothorax, It is approved by the FDA under the Humanitarian Device Exemption for use in controlling prolonged air leaks of the lung or significant air leaks that are likely to become prolonged air leaks following lobectomy, segmentectomy, or lung volume reduction surgery. Medical University of South Carolina, Charleston, SC