D24-11 Bronchoscopic Valve Placement for Bronchopleural Fistula Closure in Advanced Sjögren’s ILD: When Valves Wall Up!

Abstract Introduction Bronchopleural fistula (BPF) and Bronchoalveolar Fistulas (BAF) are dreaded complications of severe pulmonary disease. They lead to increased morbidity, mortality and prolonged hospitalization. Treatment options remain limited to chest tube drainage, long wait times hoping for cessation of the air leak, followed by surgical exploration and / or chemical pleurodesis for cases that fail to resolve with conventional therapy. There is observational data on the use of endobronchial valves (EBV) for closure of BPF / BAF. There has been one case report describing its use as a bridge to lung transplant. We present another case of a patient with BPF where EBV were used in direct coordination with a transplant program as a bridge to transplantation. Case Description A 66-year-old female with a past history of Sjogren disease related fibrotic ILD and chronic hypoxic respiratory failure on 2 LPM home O2 presented to the ED with sudden onset chest pain. Imaging revealed a left sided secondary spontaneous PTX requiring chest tube drainage with multiple chest tubes. She had a persistent air leak for 2 weeks; surgical pleurodesis was not offered due to severe underlying lung disease and chemical pleurodesis was to be avoided after consultation with the lung transplant program. Interventional Pulmonary was consulted and, after coordination with a transplant program, a bronchoscopy with systematic exploration of the air leak revealed LB3 as the most likely culprit. The segment was occluded with a single 5.5 LP Zephyr EBV which led to a decrease in the air leak from continuous to intermittent. Unfortunately, this did not allow for removal of the chest tube(s) so a decision was made to block the entire left upper lobe with additional EBVs (required additional 3 EBV to LB1, LB2 and LB4/5). This led to complete cessation of the air leak and allowed removal of the chest tubes. The patient was discharged shortly thereafter and eventually listed for lung transplant at a higher center. Discussion The non-surgical treatment of BPF / BAF remains unreliable except for prolonged chest tube placement. EBV placement has been reported to be safe and effective in treatment of patients unsuitable for surgery or when chemical pleurodesis fails. Our case highlights successful closure of BPF with EBV in a patient with advanced fibrotic ILD and helped in bridging to transplant listing. EBV placement should be considered for BPF / BAF closure in advanced lung disease or as a bridge to transplantation. This abstract is funded by: None