B46-20 Bleb Formation Following Bronchoscopic Lung Volume Reduction

Abstract Introduction Bronchoscopic lung volume reduction (BLVR) is an emerging minimally invasive therapeutic option designed to improve the quality of life in patients with advanced emphysema. BLVR is associated with several well-known complications including pneumothorax (up to one third of cases), pneumonia, chronic obstructive pulmonary disease (COPD), exacerbation, respiratory failure, valve migration, and hemoptysis. We report a case of post-BLVR pneumothorax with subsequent bleb formation requiring surgical management. This case demonstrates a novel post valve complication and underscores the importance of continued vigilance and multidisciplinary monitoring following BLVR. Patient Information: A 57-year-old male with COPD GOLD Stage IV Centrilobular Emphysema underwent left lower lobe BLVR with endobronchial valves placed in LB 6, LB 8, LB 9, and LB 10. Post-procedure course was uneventful, and he was discharged home on room air after three days of routine monitoring. Ten days post-discharge, the patient presented to the emergency room for acute left-sided pleuritic chest pain. Chest imaging demonstrated a left-sided hydropneumothorax, and a chest tube was placed, leading to improvement in symptoms. Patient was admitted to inpatient pulmonary service. Despite tube drainage, follow-up imaging demonstrated persistent pneumothorax. On hospital day three, a follow-up bronchoscopy was performed with removal of the LB 6 endobronchial valve and the placement of a new chest tube. CT imaging on hospital day 6 confirmed appropriate tube placement but persistent hydropneumothorax, suggesting bronchopleural fistula. On hospital day seven, thoracic surgery was consulted, and the patient underwent video-assisted thorascopic surgery (VATS), during which a large bleb, not present on pre-BLVR high resolution CT imaging, was identified and resected. Following the procedure, the patient’s pneumothorax resolved, and his recovery was uneventful. Discussion Bronchoscopic lung volume reduction (BLVR) with endobronchial valve placement is an important therapeutic option in patients with severe, symptomatic emphysema. Current guidelines and multicenter studies note specific post-procedure adverse events including pneumothorax, device-related issues, and infection. This case illustrates the development of a large bleb following BLVR, a complication not previously described in the literature. This abstract is funded by: None