Intrapleural Therapy for Empyema in the Setting of a Bronchopleural Fistula: A Novel Use of an Intrabronchial Valve

Abstract

Postsurgical empyema with bronchopleural fistula can be difficult to manage. We present a patient with postoperative empyema with bronchopleural fistula who was successfully treated nonoperatively by placing an intrabronchial valve to address the bronchopleural fistula, which allowed for safe administration of intrapleural fibrinolytics and antibiotics for definitive treatment of the empyema. Although the presence of a bronchopleural fistula is considered a contraindication to the administration of intrapleural tissue plasminogen activator and deoxyribonuclease, this case demonstrates a novel use of the intrabronchial valve that allowed these medications to be used.

Late-onset bronchopleural fistula after lobectomy and adjuvant chemotherapy for lung cancer

“…[31] Besides, endobronchial valves are well tolerated and effective for patients with BPF, [32] which facilitate administration of intrapleural fibrinolytics and antibiotics for definitive treatment of empyema. [33] A multimodal approach including insertion of tracheobronchial conical stent, open pleural packing, and closure of bronchial stump with omentoplasty is particularly effective for BPF with empyema. [34] Finally, evidence for bronchial stump reinforcement leading to a reductive incidence of BPF is conflicting.…”

Value of a Multidisciplinary Team Approach to Treatment of Emphysema

“…These 1-way valves limit airflow into the pleural space while allowing backflow of mucus and air. 117 EBV placement is most commonly used for persistent pneumothorax secondary to PAL as opposed to BPF with concomitant empyema; however, use in BPF is gaining traction. 118 One series of 3 critically ill mechanically ventilated patients with BPF found immediate air leak resolution after EBV placement followed by BPF resolution and extubation within 5 to 13 days and good long-term survival.…”

Advanced Endoluminal Technologies for Barrett's Esophagus

“…These 1-way valves limit airflow into the pleural space while allowing backflow of mucus and air. 117 EBV placement is most commonly used for persistent pneumothorax secondary to PAL as opposed to BPF with concomitant empyema; however, use in BPF is gaining traction. 118 One series of 3 critically ill mechanically ventilated patients with BPF found immediate air leak resolution after EBV placement followed by BPF resolution and extubation within 5 to 13 days and good long-term survival.…”