High-flow bronchopleural fistula: Endobronchial management

Management of bronchopleural fistula (BF) is challenging, especially among patients receiving mechanical ventilation (MV), because insufflation pressure causes significant air leak. In patients who are not receiving MV, the main problem is empyema. In both situations fistula diameter determines treatment. We describe a case of a patient with 2 large sequential BFs. The first one was due to a cavitary pneumonia that led to acute respiratory distress syndrome and necessitated extracorporeal membrane oxygenation and an emergency right superior bilobectomy for a massive hemothorax. The second BF developed due to the breakdown of a suture line after the bilobectomy. Repeated closure attempts were performed using synthetic fibrin, resulting in temporary occlusions allowing weaning from MV. Definitive closure was established by endoscopic placing of metallic coils and instillation and submucosal injection of cyanoacrylate. Copyright © 2006 by Lippincott Williams & Wilkins.