Abstract Endobronchial valves (EBVs) are one-way devices initially designed for bronchoscopic lung volume reduction in emphysema. Their use has expanded to the management of persistent air leaks after surgery or trauma as well as spontaneous pneumothoraces, particularly in nonsurgical candidates. Compared to other minimally invasive occlusion methods such as fibrin glue or coils, EBVs permit secretion drainage, can be placed in larger airways, and are easily reversible. We present a case in which EBV placement successfully stabilized a rapidly expanding bronchopleural fistula (BPF) by restoring pleural integrity and enabling effective chest tube function. A 34-year-old male with a self-inflicted left-sided gunshot wound (GSW) one month prior presented with pleuritic chest pain, discharge from bullet entry site, and focal chest wall outward ballooning with cough. During initial hospitalization, he underwent emergent left thoracotomy with extension to sternotomy for massive hemorrhage, with discovery of a through-and-through bullet wound at superior segment of left lower lobe (LLL) that was addressed with a left lower lobe wedge resection, pulmonary artery ligation, and placement of two chest tubes. He was discharged two weeks prior to current presentation. On arrival, he was stable on room air. CT chest revealed an air-filled tract extending from the anterior left chest wall, through the lingula and superior segment of the left lower lobe, consistent with a recurrent BPF. After multidisciplinary discussion regarding the risks associated with repeat thoracotomy, patient was taken for emergent ultrasound guided 14F thoracostomy tube placement for stabilization of air leak, followed by Zephyr EBV placement for control of air leak source. Successive balloon occlusion testing guided placement of two EBVs at lingula and LLL, with near cessation of air leak. Patient reported immediate improvement in symptoms. Two days later, two additional EBVs were placed and pleurodesis with blood patch was performed for ongoing air leak. Air leak ceased on day ten of admission, prompting removal of pigtail without re expansion of pneumothorax. Close follow up with Cardiothoracic Surgery for definitive treatment was planned. This case illustrates a novel physiologic use of EBVs to restore pleural integrity in the setting of a bronchopleural fistula with expanding subcutaneous emphysema. By temporarily sealing the airway defect, EBV placement re-established pleural vacuum dynamics, allowing effective chest tube function. This reversible approach offers a minimally invasive bridge to definite repair or recovery when standard chest tube drainage fails. This abstract is funded by: None
Rubel et al. (Fri,) studied this question.
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