Combined intrapleural and intrabronchial injection of fibrin glue for closing alveolar pleural fistula: a case report
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(2019) 14:171
CASE REPORT
Open Access
Combined intrapleural and intrabronchial injection of fibrin glue for closing alveolar pleural fistula: a case report Alfonso Fiorelli1* , Italia Odierna2, Daniele Scarano2, Francesco Caronia3, Andrea Failla4, Mario Iannotti2, Mario Santini1 and Caterina Pace5
Abstract Background: The treatment of persistent air leak is a challenge. Herein, we reported the combined intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy to seal off an alveolar pleura fistula developed following necrotizing pneumonia in high-risk patient. Case presentation: A 74-year-old man was intubated in emergency for acute ischemic stroke. Percutaneous dilatational tracheostomy was then performed, and 15 days later patient returned to spontaneous breathing. However, he developed alveolar pleural fistula following necrotizing pneumonia with persistent air leaks. The intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy sealed off the alveolar pleura fistula after that other endoscopic treatments as bronchial valve and intrabronchial fibrin glue application had failed. Conclusions: Our strategy is safe and easy to reproduce. It represents an additional method in the armamentarium of the physicians for the management of PAL when all standard strategies are unfeasible or fail. Keywords: Persistent air leaks, Alveolar pleural fistula, Fibrin glue, Case report
Introduction PAL is a frustrating clinical condition due to a pathological communication between the lung and pleural space [1]. It may be associated with significant morbidity, mortality and prolonged hospital stay; thus, an early resolution is desirable. In the years, conservative, surgical and endoscopic techniques have been reported to manage this pathological condition, but the best treatment is still debate [2, 3]. Herein, we reported a new approach as the intrabronchial and intrapleural injection of FG using fiber bronchoscopy to seal off APF developed following necrotizing pneumonia in high-risk patient. The procedure was successful after that other endoscopic treatments as bronchial valve and intrabronchial FG application had failed.
* Correspondence: [email protected] 1 Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, I-80138 Naples, Italy Full list of author information is available at the end of the article
Case presentation A 74-year-old man was intubated in emergency for acute ischemic stroke, and then referred to Anesthesiology and Intensive Care Unit of our hospital. The patient’s medical history included cardiac disease and COPD. PDT was then performed, and patient returned to spontaneous breathing 15 days later. Despite systemic administration of broad-spectrum antibiotics (Vancomycin, Cefepime, and Azithromycin), he developed APF following necrotizing pneumonia that complicated with pneumothorax, empyema and subcutaneous emphysema (Fig. 1a). A 32 French tube was placed at the 5th intercostal space anterior axillar line with dra
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