A47-37 Patching A Leaky Situation - From Septic Emboli to Pneumothorax

Abstract Introduction Persistent Air Leaks (PALs) are a common complication of secondary spontaneous pneumothorax (SSP). An air leak is considered a PAL if it persists beyond 5-7 days 1. In patients with non-surgical SSP, the estimated prevalence of air leaks was 81.1% at 2 days and over 43.3% at 7 days 2. The presence of PALs is associated with higher morbidity and prolonged hospital stays. Standard management typically involves surgical intervention when a PAL persists despite chest tube placement 3. However, this case highlights a patient who was managed conservatively due to her compromised hemodynamic and nutritional status. Case Presentation A 31-year-old female with a history of intravenous drug use (IVDU) presented to the ER with generalized weakness and back pain. She was initially hypotensive and tachycardic. Workup revealed severe sepsis due to pulmonic valve endocarditis with septic embolization to the lungs and mildly decreased right ventricular (RV) function. Her course was complicated by chest pain and worsening respiratory distress due to a left-sided pneumothorax, likely related to the septic emboli. The pneumothorax initially resolved with left-sided chest tube placement but recurred upon removal, necessitating re-insertion. Given the high risk of recurrence and her unstable physiological state, non-surgical management was pursued, including autologous blood patching with successful pleurodesis. Discussion This case underscores the challenges of managing a patient with PAL who is a poor candidate for surgical intervention due to her poor nutritional status (which affects wound healing and increases the risk of infection) and tenuous hemodynamic state. In 2023, the British Thoracic Society recommended chemical pleurodesis for patients requiring prevention of recurrent SSP, particularly in those with significant decompensation or high recurrence risk 4. However, studies and meta-analyses have suggested that autologous blood patching (ABP) is non-inferior to chemical agents like talc and even surgical interventions 5. ABP also mitigates the risks of complications associated with chemical pleurodesis, such as carcinogenic potential, and is typically less painful, not requiring sedation—which could have further compromised our patient’s outcome 5. Conclusion PALs remain a common issue after SSP, contributing to prolonged hospital stays and increased morbidity. Many of these patients have underlying lung pathologies that limit their ability to tolerate surgical management. ABP may offer a safe, non-inferior alternative for managing these patients. This abstract is funded by: None