Long-term follow-up of intralobar bullae after endobronchial valve treatment for emphysema

O. Taton*^a (Dr), V. Heinen^b (Prof), B. Bondue^a (Prof), DJ. Slebos^c (Prof), P. Shah^d (Prof), K. Carron^e (Dr), O. Moens^a (Dr), D. Leduc^a (Prof)

^a Hôpital Erasme, Université Libre de Brussels, Brussels, Belgium, Bruxelles, BELGIUM ; ^b Department of Pneumology, Centre Hospitalier Universitaire de Liège, Liège, Belgium, Liege, BELGIUM ; ^c Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Groningen, NETHERLANDS ; ^d Royal Brompton Hospital, London, London, UNITED KINGDOM ; ^e Department of Pneumology, AZ Delta, Menen, Belgium, Menen, BELGIUM

* olivier.taton@erasme.ulb.ac.be

Background

Endoscopic lung volume reduction using unidirectional endobronchial valves (EBV) is a new technique in the treatment of patients with severe emphysema. However, the movements of the thoracic structures after endobronchial valves insertion are still unpredictable. We report the unusual outcome of six patients after valves insertion in the left upper lobe (LUL).

Case Reports

These six patients developed septate and isolated bullae in their left lung within 48 hours after EBV insertion in their LUL. All patients fulfilled the key selection criteria for endoscopic lung volume reduction therapy. Careful examination of their chest CT scan performed before valves insertion showed absence of bulla adjacent to the target lobe, paraseptal emphysema, severe scaring, fibrotic lesions and significant pleural adhesions.

All had LUL treatment and the appearance of the bullae occurred concomitantly with a rapid loss of volume of the target lobe complicated by a pneumothorax within two days after EBV insertion.

The outcomes of patients 1, 2 and 3, were uneventful with complete resolution of the bullae. An air-liquid level in the LUL bullae occurred within two days after EBV placement in patients 4, 5 and 6 and was associated with a bacterial infection. A six week antibiotic treatment was given.

Conclusions

Parenchymal or interlobar bulla is a complication after endobronchial valves insertion for endoscopic lung volume reduction in patients with severe emphysema. In case of bulla without an air-liquid level, a conservative attitude should be taken as spontaneous resolution was described, whereas in presence of an air-liquid level in the bulla, antibiotic prophylaxis should be discussed to prevent secondary infection. In both situations, there is a complete resolution of those bullae.

Disclosure of funding source(s):

OT, VH, BB, KC, OM and DL have no conflicts of interest in this work. DJS is a physician-advisor and investigator for Pulmonx, CA, USA. PS received lecture fees and is a consultant of Pulmonx, CA, USA.