Use of fibrin glue to treat a persistent pneumothorax with bronchopleural fistula.

PURPOSE: A case of spontaneous pneumothorax with a subsequent bronchopleural fistula (BPF) treated with endoscopically administered fibrin glue is presented.

SUMMARY: A 76-year-old white man with a history of a benign lung mass and chronic obstructive pulmonary disease was admitted to the hospital with right-sided, anterior, pleuritic chest pain for the past three days and shortness of breath at rest, which worsened during exertion. Initial chest radiograph revealed a right 95% spontaneous tension pneumothorax. A chest tube was immediately placed in the right pleural space, resulting in reinflation of the lung. However, air leaks continued to be present, requiring the need for surgical intervention. The patient required both coronary artery bypass graft surgery and right blebectomy with pleurodesis. Postsurgery, the patient required two pleural chest tubes for the persistence of a BPF. A critical care clinical pharmacist was consulted regarding potential use of an endoscopic fibrin seal. Fiberoptic bronchoscopy was performed, and diffuse bronchiectasis was noted in all right lower respiratory airways. The day after the fibrin sealant was administered, one of the pleural chest tubes was removed because the air leak was significantly reduced in size. The patient was discharged home two days later with a Heimlich chest valve. One week postdischarge, a chest radiograph revealed no pneumothorax.

CONCLUSION

Use of a fibrin sealant injected through a fiberoptic bronchoscope was effective in reducing an air leak associated with a spontaneous pneumothorax and subsequent BPF.