SESSION TITLE: Bronchology Global Case Reports
SESSION TYPE: Global Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Bronchopleural fistula (BPF) is a complication, mostly encountered after lung surgery and invasive diagnostic procedures but it’s rarely seen due to tuberculosis. The standard methods of treating persistent air leak include continued chest tube suction, Heimlich valves or surgical repair. In patients not suitable for surgery due to extensive inflamatory process, bronchoscopic approaches may bring to a successful conclusion. This is the first description of the use of a removable, one-way, endobronchial valve(EBV) to treat BPFs with non-resolving spontaneous pneumothorax complicating extensive cavitary pulmonary tuberculosis(PTB).
CASE PRESENTATION: 21-year-old- male patient was admitted with complaints of cough and sputum for 10 days. Chest X ray showed cavitary lesions with reticulonodular changes in the right upper lung field. Sputum smear was positive for acid fast bacilli. Thus, the patient was diagnosed as PTB and antituberculosis therapy was started. Three days later, the patient developed acute dyspnea and right chest pain. Chest X ray demonstrated a right hydropneumothorax. A chest tube drainage was applied on the right side. Even under negative pressure, chets tube drainage did not work and radiological controls showed no resolution of hydropneumothorax. Because of the early period of PTB and intense inflammation of lung parenchyma, surgical treatment was not considered at this stage and open drainage was performed. Thorax CT scans revealed partly collapse of upper lobe and completely collapse of lower lobe. After possible places of air leakage was observed, it was planned to insert EBVs in related segments of upper lobe. Occlusion of apical and posterior segments was attempted using the balloon catheter passed through a bronchoscope and the air leak stopped immediately. After that, two EBVs were placed in the apical and one was placed in the posterior-segment bronchi. After a while, air leak stopped and, thorax CT showed complete resolution of hydropneumothorax and almost complete regression of cavities after 3 months.
DISCUSSION: There are successful case reports using EBVs for spontaneous pneumothorax and prolonged air leak due to lung surgery, empyhema, malignancy and thoracic trauma1-3. To our knowledge, this is the first case that used a one-way endobronchial valve to manage severe air leak due to extensive PTB.
CONCLUSIONS: One-way endobronchial valve replacement for a bronchopleural fistula may be the initial approach before surgical procedures in critically ill patient.
Reference #1: Feller-Kopman D, Bechara R, Garland R, et al. Use of a removable endobronchial valve for the treatment of bronchopleural fistula. Chest 2006; 130:273-275
Reference #2: Anile M, Venuta F, De Giacomo T, et al. Treatment of persistent air leakage with endobronchial one-way valves. J Thorac Cardiovasc Surg 2006; 132:711-712
Reference #3: Travaline JM, McKenna RJ, Jr., De Giacomo T, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest 2009; 136:355-360
DISCLOSURE: The following authors have nothing to disclose: Mehmet Aydogan, Alper Gündogan, Ergun Uçar, Hasan Çaylak, Orhan Yücel, Ergun Tozkoparan, Sedat Gürkök, Hayati Bilgiç
No Product/Research Disclosure Information