C60-17 Persistent Air Leak in a Pediatric Patient: Innovative Use of Endobronchial Valve

Introduction Persistent air leak (PAL) in children is a rare but challenging condition with limited established treatment strategies. Management ranges from conservative to surgical interventions, while the role of advanced bronchoscopic techniques remains poorly defined. We present a case of young boy with hydatid cystic lung disease who developed PAL following surgical resection and was successfully treated with endobronchial valve (EBV) placement. Case Presentation A 5-year-old boy with no significant past medical history presented with two-month history of progressive dyspnea, chest pain and intermittent fevers. He had a travel history to Iraq with exposure to sheep. Chest computed tomography (CT) revealed bilateral pulmonary cysts measuring 5.7 cm on the right lower lobe and 6.7 cm in the left upper lobe. Serologic testing was positive for Echinococcus antibody IgG, confirming diagnosis of bilateral pulmonary hydatid cysts. He underwent pulmonary resection of the right sided cyst. The postoperative course was complicated by right sided hemothorax and PAL managed with surgical washout, pigtail chest tube placement, autologous blood patch pleurodesis, and mechanical pleurodesis with initial resolution. Four weeks later, he was readmitted with enlarging right sided hydropneumothorax. A chest tube was reinserted and repeat pleurodesis was performed without improvement of PAL. CT angiography demonstrated bronchopulmonary fistula (BPF) involving the right middle lobe bronchus. Bronchoscopy with balloon occlusion confirmed site of leak. A standard 4.0 endobronchial valve was deployed in the right middle lobe, resulting in immediate cessation of the air leak. The chest tube removed, and the patient was discharged home nine days after valve placement. Discussion PAL contributes to significant morbidity and prolonged hospitalization in children. The underlying mechanism is typically a BPF secondary to necrotizing pneumonia, cystic lung disease, trauma or postoperative complication. Standard management includes chest tube drainage and pleurodesis, though outcomes are variable. Advanced bronchoscopic techniques such as airway stent, sealants, and EBVs are well described in the adult population but remain underreported in the pediatric world. Several case reports and small series have demonstrated the efficacy of EBVs for PAL in children. In this case, EBV was an effective and precise intervention with favorable outcome after multiple failed interventions. This highlights the potential role of EBV as minimally invasive therapeutic option in selected pediatric patients when conservative and surgical treatments are unsuccessful.