Page 75 - ECBIP 2021_Program

MODERATED e-POSTER SESSION 07:
Lung Cancer
PP46
Introduction: Data shows that endobronchial valves (EBVs) are effective in treating refractory pneumothoraces by stopping persistent air leaks (PAL)[1]. We describe the first case in which EBVs were used to induce collapse of the right lung (medical pneumonectomy) to resolve PAL in very challenging circumstances.
Case Summary: A 62 year old male patient, lifelong smoker, developed right sided pneumothorax (day 0) after both main bronchi were stented for newly diagnosed non-resectable lung cancer. He was known to have ischaemic heart disease, hypertension and severe COPD. As 12Fr Seldinger chest drain proved to be inadequate with non-resolving pneumothorax and worsening surgical emphysema; a 32Fr surgical drain was inserted (day3) and attached with
low pressure, high volume suction. In view of PAL despite the above measures, blood patch pleurodesis (day 6) was attempted but was not successful. Due to inoperability of lung cancer and very low FEV1 of 36% predicted, he was deemed unfit for surgical intervention by the Thoracic surgical team. Following multi-disciplinary discussion, the right main bronchus (RMB) stent was removed (day 13), to allow re-occlusion of that lung. However, this did not happen spontaneously. Hence, 21 days after developing a pneumothorax, with an ongoing leak, 5 EBVs were placed, to occlude right lower and middle lobes. This, combined with previous right upper lobe occlusion due to the tumour, led to complete collapse of right lung and immediate resolution of the PAL.The patient was discharged on day 25 and has gone on to have immunotherapy as oncological treatment and remains independent with a good quality of life.
Conclusion: This is the first reported case in which EBVs were successfully used to achieve pneumostasis by completely occluding the right lung, as standard interventions, including multiple chest drains, suction and blood pleurodesis, had proved ineffective.
References:
1. Ding M, Gao YD, Zeng XT, et al. 2017. Endobronchial one-way valves for treatment of persistent air leaks: a systematic review. Respir Res, 18(1):186
Figure 1: Endoscopic view of RMB showing Figure 2: One of the 4 EBVs in RLL.Very narrowed RML completely occluded RUL and narrowed RBI bronchus is also in view where another EBV was sited.
UNIQUE CASE OF “MEDICAL PNEUMONECTOMY” USING ENDOBRONCHIAL VALVES (EBVS) IN A PATIENT WITH REFRACTORY PNEUMOTHORAX AND PERSISTENT AIR LEAK (PAL)
Saad Qutab1, Benjamin Ayeboah-Sallah2, James Wilkinson2, Neel Sharma2
1 Conquest Hospital, Hastings, United Kingdom
2 Eastbourne District General Hospital, Eastbourne, United Kingdom
ECBIP 2021 75
6th European Congress
for Bronchology and Interventional Pulmonology
OCTOBER ECBIP 15 - 17
ATHENS - GREECE 2021
Book of Abstracts