Endobronchial blood patch with thrombin injection

Abstract

Abstract Introduction: Persistent pulmonary air leaks present a challenging clinical problem, often requiring surgical intervention that not all patients can withstand. Patient concerns: An elderly female with severe emphysematous Chronic Obstructive Pulmonary Disease and dependent on continuous home oxygen supplementation developed recurrent pneumothoraces. On evaluation, the patient was considered a poor surgical candidate for Video assisted thoracoscopic surgery, and therefore a less invasive approach to treat the recurrent pneumothoraces was required. Diagnosis: A diagnosis of recurrent right pneumothorax due to Pulmonary-parenchymal fistula (either alveolo-pleural fistula or broncho-pleural fistula) was made Interventions: Due to the fragile overall condition of the patient, the peri-procedure risk of video assisted thoracoscopic surgery was not acceptable. Hence bronchoscopic evaluation with an endobronchial blood patch with thrombin injection was performed using a swan-ganz catheter. Outcomes: The patient had significant reduction in air leak post procedure and achieved complete resolution on day 3. She was successfully discharged home later. Conclusion: In patients with significant comorbidities that preclude standard interventions for persistent pulmonary-pleural fistulas, endobronchial blood patch repair with thrombin injection can be safely performed utilizing a swan-ganz catheter.