C44-17 Managing Recurrent Pneumothoraces After Bronchoscopic Lung Volume Reduction (BLVR): A Case for Talc Pleurodesis

Abstract Introduction Pneumothorax is a common complication in patients with severe emphysema. Recurrent episodes, particularly in those with prior bronchoscopic lung volume reduction (BLVR), present unique management challenges. The role of pleurodesis in this setting remains unestablished. We present a case of recurrent pneumothoraces in a patient with prior BLVR managed with this approach adding to the limited body of evidence for pleurodesis in such complex clinical situations. Case Description A 61-year-old woman presented with acute dyspnea and was found to have a large left-sided pneumothorax necessitating chest tube placement. She had a history of BLVR performed 36 months prior to presentation for bullous emphysema with valves placed in her primary target, left lower lobe, achieving successful lobar reduction on post-op day 0. Notably, patient was discharged one week prior to current presentation after management of a pneumothorax. Despite initial improvement and successful removal of her chest tube, she developed a recurrent pneumothorax 3 days later requiring chest tube reinsertion. Given multiple recurrences, she underwent talc pleurodesis on hospital day 8. Serial imaging demonstrated resolution of the pneumothorax with chest tube removal on day 20. Despite remaining pneumothorax free, her course was complicated by worsening hypercarbia and poor BiPAP tolerance. In the setting of advanced disease and limited treatment tolerance, care was transitioned to comfort measures. Patient passed away four weeks after pleurodesis, during which she remained pneumothorax free. Discussion and learning points Pneumothorax is a well-recognized complication of severe airspace disease such as emphysema. BLVR can be an effective minimally invasive therapeutic option to improve lung function and quality of life in patients with severe emphysema, however the intervention may complicate the management of later pneumothoraces. The role of pleurodesis in management of pneumothorax in patients with prior BLVR remains unestablished due to the potential interference with lung re-expansion dynamics and the formation of dense pleural adhesions, limiting future interventions, such as valve revision, or lung transplantation candidacy. However, in select patients, it may provide therapuetic advantage. In our case, given the patient’s advanced disease and high risk of respiratory decompensation with valve removal, talc pleurodesis was pursued as a lung-preserving measure, likely addressing pneumothorax from progressive ipsilateral disease rather than valve-related atelectasis. Case-by-case consideration is essential, since pleurodesis on a collapsed lobe can cause significant pain upon re-expansion. Our case illustrates the potential utility of talc pleurodesis as a salvage approach and reinforces the importance of individualised patient care. This abstract is funded by: None