C79-09 Covered Metal Airway Stenting for Persistent Postoperative Air Leak in a Patient With Recurrent Cardiac Sarcoma

Abstract Introduction Bronchopleural Fistula (BPF) remains a rare but serious post-operative complication associated with significant morbidity. Historically, surgical repair was the primary option for large BPF, but bronchoscopic interventions have expanded treatment options. We present a case of a directly visualized large airway defect successfully managed with covered metal airway stent. Case Presentation A 23-year-old female with history of cardiac sarcoma status post-surgical resection, chemotherapy, and radiation therapy presents with progressive dyspnea on exertion. Imaging revealed a large posterior mediastinal mass with spinal metastasis and biopsy confirmed recurrent high-grade sarcoma. She underwent a two-stage palliative surgical mass resection with pulmonary wedge resection and corpectomy with spinal fixation. On post-operative day (POD) 5, she developed grade 4 air leak. Chest computed tomography revealed findings concerning for a bronchopleural fistula with persistent pneumothorax. Bronchoscopy revealed a right lower lobe superior segment airway defect with direct visualization of the pleural space and pericardium. Placement of endobronchial valve (EBV) failed to resolve the air leak. A 10x30 mm self-expanding covered metal stent was deployed into the bronchus intermedius and right lower lobe, with fenestration created to maintain right middle lobe ventilation. The air leak resolved immediately, allowing for chest tube removal and discharge home on POD 10. On follow up, the stent remains in place due to tumor recurrence and associated airway obstruction. Discussion Management of BPF depends on the size, location and patient co-morbidities, necessitating an individualized approach. Bronchoscopic approaches include sealants, EBVs, and occluder devices which have shown utility in non-surgical candidates. However, these options have limitations for large or complex defects with concurrent pathology, such as malignant airway obstruction. Airway stents offer a versatile option by simultaneously sealing the defect and maintaining airway patency. Han et al reported successful use of customizable metal stents for postoperative BPF management under fluoroscopic guidance. In this case, direct visualization enabled precise stent placement and fenestration, allowing for a personalized and effective approach to BPF management. The stent continues to offer therapeutic benefit amid tumor recurrence with associated external airway compression. This case underscores the value of advance bronchoscopic techniques in managing complex BPFs, highlighting the multipurpose advantage of covered metal stents. This abstract is funded by: none