Successful Treatment of a Giant Emphysematous Bulla by Bronchoscopic Placement of Endobronchial Valves

Noppen, Marc; Tellings, Jean-Claude; Dekeukeleire, Tom; Dieriks, B.; Hanon, Shane; D’Haese, Jan; Meysman, Marc; Vincken, Walter

doi:10.1378/chest.130.5.1563

Cited by 23 publications

(14 citation statements)

References 6 publications

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“…Less invasive and safer alternative treatments would thus be preferable. A recent report has shown that bullae can be successfully treated by bronchoscopic placement of one way valves for endobronchial blockage 3. Bronchoscopic lung volume reduction for emphysematous lung diseases is under development, and several different approaches are currently being investigated 3 – 5.…”

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confidence: 99%

Intrabullous blood injection for lung volume reduction

Kanoh

Kobayashi

Motoyoshi

2008

Thorax

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Bronchoscopic treatment for emphysematous lung diseases has attracted clinical attention, and several different approaches are being investigated. We present a case of emphysematous bullae that was effectively treated with a newly developed bronchoscopic intervention, autologous blood injection. A 59-year-old man was referred to our institution with exertional dyspnoea. Chest CT showed emphysema and bullae with a diameter of 12 cm in the right upper lobe. Bronchoscopic treatment was introduced as an alternative to surgery. Autologous blood and fibrinogen solution were infused into bullae via the transbronchial catheter, under fluoroscopic guidance. Post-treatment CT showed marked contraction of bullae to a diameter of 3 cm, corresponding to a volume reduction of 800 ml on body plethysmography. A significant reduction in dyspnoea was also noted. This therapeutic approach is less invasive and may represent a good option for reducing lung volume.In patients with emphysematous bullae, surgical bullectomy has been the treatment of choice, depending on size, location and intensity of symptoms.1 Indeed, bullectomy provides significant improvements in dyspnoea, gas exchange and pulmonary function.2 However, the surgical procedure is not without risks of both complications and mortality.

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confidence: 99%

Intrabullous blood injection for lung volume reduction

Kanoh

Kobayashi

Motoyoshi

2008

Thorax

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“…The patient was discharged the day after with improved breathlessness. A month later, forced expiratory volume at 1 s but not carbon monoxide diffusion capacity improved [60]. A difference, despite a comparison between two different conditions such as before and after a therapeutic procedure being questionable 1 month after valves placement, our patient showed improvement both in dynamic lung volumes and in carbon monoxide diffusion capacity (Table 1).…”

Section: Discussionmentioning

confidence: 66%

Use of endobronchial valves in persistent air leaks: a case report and review of the literature

Ambrosino

Ricci

Allidi

et al. 2013

Expert Review of Respiratory Medicine

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Air leaks are observed after lung surgery, but can also occur spontaneously even in a previously normal lung. There are several available methods of management including, among others, chest drainage, Heimlich valves, surgical repair or pleural decortication. However, in some of these patients, surgery may be contraindicated. In this article, the authors report the use of one-way endobronchial valves in the treatment of a compromised patient with bullous emphysema who had previously undergone bullectomy. This approach resulted in improvement of dyspnea and exercise capacity. Use of endobronchial valves is an effective, nonsurgical, minimally invasive intervention for patients with prolonged pulmonary air leaks not suitable for surgical procedures.

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“…In the setting of severe bullous disease or in respiratory insufficiency secondary to bullous emphysema, placement of EBVs aids in the deflation of the bullae [6,7] and can improve respiratory function [8,9]. There is also a single case report of transbronchial decompression using needle aspiration of proximal bullae.…”

Section: Clinical Discussionmentioning

confidence: 99%

Percutaneous Bullectomy in Conjunction with Endobronchial Valve Placement as an Alternative to Surgical Management of Giant Bullae

Goud¹,

Krimsky

Caldwel³

et al. 2016

Respiration

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We present the first reported case of the treatment and management of a giant bulla using percutaneous bullectomy and endobronchial valve placement. A 74-year-old woman with chronic obstructive pulmonary disease and a known large bulla in the left chest presented to the emergency department with acute-onset confusion after a traumatic fall. She was subsequently diagnosed with an intracranial hemorrhage in the distribution of the right basal ganglia. Chest imaging revealed a giant apical bulla occupying 80% of the left hemithorax. In addition, there was midline shift away from the affected side associated with volume loss in the right hemithorax and no radiographic evidence of aeration in the remainder of the left lung. Arterial blood gas analysis revealed significant hypercapnia. Surgical bullectomy was not an option, and thus, a novel approach was utilized to treat this patient.

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Successful Treatment of a Giant Emphysematous Bulla by Bronchoscopic Placement of Endobronchial Valves

Cited by 23 publications

References 6 publications

Intrabullous blood injection for lung volume reduction

Intrabullous blood injection for lung volume reduction

Use of endobronchial valves in persistent air leaks: a case report and review of the literature

Percutaneous Bullectomy in Conjunction with Endobronchial Valve Placement as an Alternative to Surgical Management of Giant Bullae

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