Fresh frozen plasma pleurodesis for bronchopleural fistula following secondary spontaneous pneumothorax due to ruptured emphysematous bullae in a high-risk elderly COPD patient.

INTRODUCTION

Persistent air leak (PAL) secondary to bronchopleural fistula (BPF) is a serious complication of secondary spontaneous pneumothorax (SSP) resulting from ruptured emphysematous bullae in patients with chronic obstructive pulmonary disease (COPD). Management is particularly challenging in elderly high-risk individuals who are unsuitable for surgical intervention. Fresh frozen plasma (FFP), containing fibrinogen and coagulation factors, may act as a biological sealant and facilitate pleural closure.

CASE REPORT: A 76-year-old man, a former smoker with COPD and multiple comorbidities presented with severe acute dyspnea and persistent cough due to right-sided pneumothorax with lung collapse. A water-sealed intercostal chest drain was inserted; although respiratory distress improved, a persistent air leak continued. High-resolution computed tomography confirmed right-sided pneumothorax with associated lung atelectasis and multiple emphysematous bullae. Given the high surgical risk, a total of three units of ABO-compatible fresh frozen plasma (FFP) were administered intrapleurally through the existing chest tube on alternate days. A gradual reduction in air leak was observed, with complete cessation by day 17. The chest tube was removed on day 20 following radiographic confirmation of full lung re-expansion. At 6-month follow-up, the patient remained clinically stable without recurrence of pneumothorax or the need for further pleural intervention.

CONCLUSION

Intrapleural FFP pleurodesis may represent a safe, feasible, and cost-effective alternative for managing persistent air leak in high-risk elderly COPD patients when surgical options are contraindicated. Complete resolution may require a prolonged course; however, the favorable outcome without complications reinforces the value of a carefully selected management strategy in this challenging clinical context.