Abstract The patient is a 66-year-old female with past medical history of rheumatoid arthritis, systemic lupus erythematosus, obstructive sleep apnea, and hypertension who initially presented to the hospital with complaints of fatigue and shortness of breath for approximately two weeks. Imaging was performed which showed bilateral interstitial changes. Her imaging findings along with her positive autoimmune markers (anti-CCP, anti-SSA, anti-PL7) raised concern for rheumatoid arthritis associated interstitial lung disease. She was started on high-dose steroid treatment as well as antibiotics which did not improve her symptoms. She then underwent bronchoscopy with transbronchial biopsies. Post procedure she was found to have large right side pneumothorax for which emergent tube thoracostomy was placed. Unfortunately, this was complicated by formation of a bronchopleural fistula. Initially, blood patch as well as endobronchial valves were attempted for resolution and were unsuccessful. Her hospital course was further complicated by development of right sided necrotizing pneumonia. She then underwent right middle and lower lobe resection with right upper lobe decortication with muscle flap placement. The case was further complicated by wound dehiscence at the flap closure with formation of a broncho-cutaneous fistula requiring continued need for right sided thoracostomy tube with Heimlich valve. The patient then underwent endobronchial valve placement once more in which two additional valves were placed in the bronchus intermedius as well as the right middle lobe where prior valves were placed. This site, in reference to the right middle lobe, was viewed to have a wide opening into the thoracic cavity. After placement, there was minimal air leak from the thoracostomy tube. Right sided thoracostomy tube was subsequently successfully removed. In total, our patient was hospitalized for approximately six months. She underwent multiple interventions such as placement of several thoracostomy tubes, endobronchial valve placement as above, complex surgical interventions involving cardiothoracic and plastic surgery, and tracheostomy cannulation. At the time of follow up, approximately seven months from her initial presentation, our patient is free of her thoracostomy tubes and has underwent tracheostomy decannulation. She currently resides at a skilled nursing facility that provides daily rehab with physical and occupation therapy. She is progressing well. This abstract is funded by: None
Psomiadis et al. (Fri,) studied this question.