Endobronchial Fluoroscopy-Guided Management of Persistent Air Leak After Video-Assisted Thoracoscopic Surgery (VATS)-Assisted Deroofing of Pleural Hydatid Cysts.

Persistent air leak (PAL) is a challenging postoperative complication after thoracic surgery. We present the case of a woman in her 30s with hydatid disease involving the abdomen and lungs, who developed PAL following video-assisted thoracoscopic surgery (VATS)-assisted deroofing of left pleural hydatid cysts. Conservative management with chest tube drainage and negative suction failed to resolve the air leak. On postoperative day seven, bronchoscopy with balloon occlusion localized the leak to the upper lobe of the left lung. A combined bronchoscopy and fluoroscopy-guided approach was used for coil embolization and glue placement in the involved airways, successfully sealing the alveolo-pleural fistula. The patient showed complete resolution of the air leak and was discharged in stable condition after chest tube removal. This case highlights the role of bronchoscopy-guided interventions as a minimally invasive alternative for PAL management, particularly in peripheral airway leaks, reducing the need for surgical re-intervention.