Pulmonary Procedures |

Persistent Bronchopleural Fistula FREE TO VIEW

Joshua Jewell, MD; Manoj Mathew, MD
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Banner Good Samaritan Medical Center, Phoenix, AZ

Chest. 2014;145(3_MeetingAbstracts):475A. doi:10.1378/chest.1829787
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SESSION TITLE: Bronchology Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Bronchopleural fistulas (BPF) have been a known complication of lung resection as well as trauma for many decades. Often times surgical correction is required, however, in certain cases surgery is not a feasible option.

CASE PRESENTATION: A 79-year old male with Stage IV 02-dependent COPD and heart failure, who is status-post left upper lobectomy 16 months earlier for a 1cm squamous cell carcinoma. This patient had subsequent recurrent pneumothoraces due to poor lung expansion and underlying parenchymal lung disease. Patient was eventually referred for further evaluation and definitive therapy. Cardio-Thoracic Surgery felt patient to be high surgical risk and a heimlich valve was placed instead. Patient had remained with this in place for greater than 1 month without resolution. After literature review, decision was made to attempt to occlude the BPF with fibrin glue bronchoscopically. Once identifying the location of BPF, which was at the left upper lobe stump, fibrin glue was injected via an introducer filling the area quickly and immediately hardening. Once this was performed there was no further identification of airleak via the heimlich valve.

DISCUSSION: Previous case reports have mentioned use of fibrin glues as a possible option, however, the methods were not clearly identified. In this case, we were able to take a 7 french introducer at 90cm length, cutting the tip to improve distal diameter, and running this through the side port of a therapeutic bronchoscope. Patient was placed under general anesthesia and bronchoscoped through a laryngeal mask airway. Once at site of BPF, the assembled fibrin glue syringe is firmly inserted into the introducer and quickly deployed, given the rapid onset of hardening. If subsequent applications are needed, new introducer will be required.

CONCLUSIONS: The use of fibrin glue applied via 90cm 7 french introducer through the side arm of a bronchoscope is a potential cure for BPF.

Reference #1: Nicholas JM, Dulchavsky SA. Successful use of autologous fibrin gel in traumatic bronchopleural fistula: case report. J Trauma, 1992;32(1):87.

DISCLOSURE: The following authors have nothing to disclose: Joshua Jewell, Manoj Mathew

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