A Case of Peripheral Bronchopleural Fistula Treated by Flexible Bronchoscopy with Gelfoam Occlusion

Lee, Seung Heon; Hur, Gyu Young; Kim, Je Hyeong; Lee, Sang Yeub; Shin, Chol; Shim, Jae Jeong; In, Kwang Ho; Kang, Kyung Ho; Yoo, Se Hwa

Abstract

A 58-year-old man was admitted after suffering dyspnea and pleuritic chest pain on his right side for one week. A chest X-ray revealed necrotizing pneumonia and a lung abscess on right upper lobe. Despite of antibiotics and supportive care, a complicated parapneumonic effusion developed on his right side. Closed thoracostomy was performed for drainage. However, after the thoracostomy, a bronchopleural fistula (BPF) occurred with a continuous air leak. After 30 days intensive therapy, the underlying necrotizing pneumonia and lung abscess resolved, but the BPF continued. Bronchoscopic treatment was performed because the patient was a poor candidate for surgery. After localizing the BPF with a systemic occlusion of the segmental bronchi, small strips of Gelfoam were placed in the suction channel of the flexible bronchoscopy, and either flushed with a saline solution or inserted with forceps until the cessation of air leak. The patient was discharged 10 days after the bronchoscopic treatment.