SESSION TITLE: Bronchology Case Report Posters II
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Bronchopleural fistulae (BPF) are an uncommon but severe complication of lung resection surgery. Endoscopic treatment of persistent leak due to small peripheral BPF has become increasingly common with the use of the Spiration IBV® (Spiration, Redmond, WA) valve. In cases of larger more central leaks not amenable to valve placement, Amplatzer® Atrial Septal Occluder (St. Jude Medical, St. Paul, MN) device placement has been reported1. We report successful placement of this device in two patients.
CASE PRESENTATION: Patient 1 - A 64-year-old female with adenocarcinoma of the lung underwent right-sided pneumonectomy. She subsequently developed dehiscence and a BPF at the right main stem stump, chronic empyema with frequent hospitalization, and permanent chest tube demonstrating persistent air leak. Bronchoscopic evaluation demonstrated a 12mm communication at the right main stem stump with the pleural space and Amplatzer® device was deployed successfully. Air leak improved immediately, and the patient has been admitted only once in the subsequent 15 months with exacerbation of symptoms. Patient 2 - A 70 year-old male with squamous cell lung cancer underwent right middle and lower lobectomy. He subsequently developed a continuous air leak, requiring placement of 4 IBV valves in the right upper lobe with resolution of the air leak at an outside institution. A large right-sided hydropneumothorax with empyema returned shortly after discharge requiring chest tube placement. Bronchoscopic evaluation demonstrated a 3 mm BPF at right lower lobe stump. Amplatzer® device was placed with resolution of the air leak. Post procedure, chest tube drainage decreased gradually and chest tube was removed two weeks later.
DISCUSSION: Spiration IBV® valves have demonstrated efficacy in closure of small peripheral BPFs, though fistula size or inability to anchor limits its use in stump leaks. In each of the above cases, the size and location of the fistulae prevented placement of a valve, or the ability to apply other sealants and required a different approach.
CONCLUSIONS: Amplatzer® device placement has been described as a novel solution to large central BPF. Our cases support the experience with these devices to date in select patients.
Reference #1: Fruchter O et al. Endobronchial Closure of Bronchopleural Fistulae Using Amplatzer Devices: Our Experience and Literature Review. Chest 2011:139:682-687.
DISCLOSURE: The following authors have nothing to disclose: Amit Goyal, Sara Greenhill, Kevin Kovitz, Neeraj Desai
The Amplatzer device is not approved for treatment of bronchopleural fistula.