Successful endobronchial valve placement in the treatment of persistent bronchopleural fistula and empyema allows the avoidance of right completion pneumonectomy.

Abstract

Introduction: This case report addresses the complexity of management of air leak and persisting infection in polymorbid patients.

Case presentation: A 56-year-old former marble mason presented with major hemoptysis. Chest CT revealed severe silicosis and pneumonia with an abscess in the right lower lobe and a pulmonary artery pseudoaneurysm. An open lower bilobectomy with empyema debridement was performed, and the posterior upper lobe segment was covered with a serratus anterior muscle flap. The second examination revealed persistent air leakage from the infected posterior upper lobe segment and necrosis of the muscle flap. Atypical resection of this segment was performed, and the surface of the lower part of the remnant lung was covered with a fat flap and then the omentum. The patient was discharged but was readmitted 2 weeks later due to empyema. During reoperation, a persistent infection in the remnant posterior upper lobe segment was observed in addition to a bronchopleural fistula. The only possible surgery that would cure the patient was right completion pneumonectomy. To avoid this high-risk operation, an endobronchial valve was placed intraoperatively in the posterior segment bronchus, leading to closure of the fistula and resolution of the infection. The patient recovered well and was discharged 10 days later. At the 1-year follow-up, the patient was free of symptoms and reported a good quality of life.

Conclusion: This case is an excellent example of successful cooperation between an interventional pulmonologist and a thoracic surgeon to avoid right pneumonectomy in a polymorbid patient.