Endoscopic treatment of a bronchopleural fistula – case report

P. Horváth*^a (Dr), T. Komáromi^a (Dr), Z. Rozgonyi^a (Dr), D. Hammer^a (Dr)

^a Semmelweis University, Budapest, HUNGARY

* horvath.peter2@med.semmelweis-univ.hu

Bronchopleural fistulas occur when there is an opening on the visceral pleura, therefore the airways and the pleural space communicate. Causes include benign conditions (empyema, suture insufficiency after surgery etc.) or as a consequence of cancer. Treatment options may be limited due to the poor general health condition of the patients. If surgery cannot be performed we have a number of endoscopic treatment options (endobronchial valves, tissue glues).

A 61 year old female patient was admitted to our Department for treatment of a pleural fluid accumulation. Thoracocentesis revealed pleural empyema. We performed chest tube insertion, followed by irrigation of the chest and broad spectrum antibiotic treatment. Continuous air leak was observed. Chest CT revealed a bronchopleural fistula on the outer surface of the lingula, contrast enhanced imaging also described a possibly malignant infiltrative disease concomitantly. We consulted thoracic surgeons, due to the tumorous infiltration they feared that suture insufficiency might occur as a consequence of surgery, therefore recommended other treatment modalities.

During bronchoscopy we performed retrograde bronchography and we found no communication with other segmental bronchi apart from left S4 and S5. After the bronchography we filled both segmental bronchi with Purastat tissue glue (3-D Matrix, Tokyo, Japan), and we applied tamponade to the bronchi with Surgicel absorbable hemostat (Ethicon, Cincinatti, Ohio, USA). After the intervention the air leak stopped, chest X-ray showed that the cavity around the trapped left lung filled with fluid. After 48 hours we removed the chest tube. Chest CT was performed a month later which showed no fistula or air in the chest cavity.

Disclosure of funding source(s): none