Percutaneous fibrin injection for the successful closure of an iatrogenic bronchopleural fistula following percutaneous lung biopsy

Abstract

Background: Bronchopleural fistula (BPF) following percutaneous lung mass biopsy is a very rare but challenging complication. We describe percutaneous fibrin injection as safe and successful in the treatment of BPF. Additionally, we present a thorough literature review of the reported treatment options of iatrogenic BPF. Summary: A 68-year-old man with a lung cancer, COPD, and multiple other comorbidities underwent an image-guided percutaneous biopsy of an enlarging right-upper lobe lung nodule that was complicated by a large iatrogenic right-sided pneumothorax requiring an image-guided placement of a drainage catheter. Four days after the catheter placement, he was diagnosed with a BPF after developing a continuous air leak, pneumomediastinum, and extensive subcutaneous emphysema. Because patient wished to avoid placement of a chest tube, endobronchial interventions, or any other invasive procedures for management of his BPF, he underwent an image-guided, percutaneous fistula closure by injection of fibrin sealant in the fistula tract. Conclusion: BPF represents a significant challenge requiring a multidisciplinary approach. Percutaneous fibrin injection in the fistula tract represents a less invasive option for patients who have small fistulae, are not operative candidates, or wish to avoid the morbidity of a major surgical interventions.