Cargando…

Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils

BACKGROUND: Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interven...

Descripción completa

Detalles Bibliográficos
Autores principales: Baden, Winfried, Hofbeck, Michael, Warmann, Steven W., Schaefer, Juergen F., Sieverding, Ludger
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9074316/
https://www.ncbi.nlm.nih.gov/pubmed/35513808
http://dx.doi.org/10.1186/s12887-022-03298-y
_version_ 1784701458255446016
author Baden, Winfried
Hofbeck, Michael
Warmann, Steven W.
Schaefer, Juergen F.
Sieverding, Ludger
author_facet Baden, Winfried
Hofbeck, Michael
Warmann, Steven W.
Schaefer, Juergen F.
Sieverding, Ludger
author_sort Baden, Winfried
collection PubMed
description BACKGROUND: Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interventional bronchoscopy is preferred in complex cases and involves the use of sclerosants, sealants and occlusive valve devices. CASE PRESENTATION: A 2.5-year-old girl was admitted to our hospital with persistent fever, cough and dyspnoea. Clinical and radiological examination revealed right-sided pneumonia and pleural effusion. The child was started on antibiotics, and the effusion was drained by pleural drainage. Following removal of the chest tube, the child developed tension pneumothorax. Despite insertion of a new drain, the air leak persisted. Thoracoscopic debridement with placement of another new drain was performed after 4 weeks, without abolishment of the air leak. Bronchoscopy with bronchography revealed a BPF in right lung segment 3 (right upper-lobe anterior bronchus). We opted for an interventional approach that was performed under general anaesthesia during repeat bronchoscopy. Following bronchographic visualisation of the fistula, a 2.7 French microcatheter was placed in right lung segment 3 (upper lobe), allowing occlusion of the fistula by successive implantation of 4 detachable high-density packing volume coils, which were placed into the fistula. Subsequent bronchography revealed no evidence of residual leakage, and the chest tube was removed 2 days later. The chest X-ray findings normalized, and follow-up over 4 years was uneventful. CONCLUSIONS: Bronchoscopic superselective occlusion of BPF using detachable high-density packing large-volume coils was a successful minimally invasive therapeutic intervention performed with minimal trauma in this child and has not been reported thus far. In our small patient, the short interventional time, localized intervention and minimal damage in the lung seemed superior to the corresponding outcomes of surgical lobectomy or pleurodesis in a young growing lung, enabling normal development of the surrounding tissue. Follow-up over 4 years did not show any side effects and was uneventful, with normal lung-function test results to date. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-022-03298-y.
format Online
Article
Text
id pubmed-9074316
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-90743162022-05-07 Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils Baden, Winfried Hofbeck, Michael Warmann, Steven W. Schaefer, Juergen F. Sieverding, Ludger BMC Pediatr Case Report BACKGROUND: Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interventional bronchoscopy is preferred in complex cases and involves the use of sclerosants, sealants and occlusive valve devices. CASE PRESENTATION: A 2.5-year-old girl was admitted to our hospital with persistent fever, cough and dyspnoea. Clinical and radiological examination revealed right-sided pneumonia and pleural effusion. The child was started on antibiotics, and the effusion was drained by pleural drainage. Following removal of the chest tube, the child developed tension pneumothorax. Despite insertion of a new drain, the air leak persisted. Thoracoscopic debridement with placement of another new drain was performed after 4 weeks, without abolishment of the air leak. Bronchoscopy with bronchography revealed a BPF in right lung segment 3 (right upper-lobe anterior bronchus). We opted for an interventional approach that was performed under general anaesthesia during repeat bronchoscopy. Following bronchographic visualisation of the fistula, a 2.7 French microcatheter was placed in right lung segment 3 (upper lobe), allowing occlusion of the fistula by successive implantation of 4 detachable high-density packing volume coils, which were placed into the fistula. Subsequent bronchography revealed no evidence of residual leakage, and the chest tube was removed 2 days later. The chest X-ray findings normalized, and follow-up over 4 years was uneventful. CONCLUSIONS: Bronchoscopic superselective occlusion of BPF using detachable high-density packing large-volume coils was a successful minimally invasive therapeutic intervention performed with minimal trauma in this child and has not been reported thus far. In our small patient, the short interventional time, localized intervention and minimal damage in the lung seemed superior to the corresponding outcomes of surgical lobectomy or pleurodesis in a young growing lung, enabling normal development of the surrounding tissue. Follow-up over 4 years did not show any side effects and was uneventful, with normal lung-function test results to date. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-022-03298-y. BioMed Central 2022-05-05 /pmc/articles/PMC9074316/ /pubmed/35513808 http://dx.doi.org/10.1186/s12887-022-03298-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Baden, Winfried
Hofbeck, Michael
Warmann, Steven W.
Schaefer, Juergen F.
Sieverding, Ludger
Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils
title Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils
title_full Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils
title_fullStr Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils
title_full_unstemmed Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils
title_short Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils
title_sort interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9074316/
https://www.ncbi.nlm.nih.gov/pubmed/35513808
http://dx.doi.org/10.1186/s12887-022-03298-y
work_keys_str_mv AT badenwinfried interventionalclosureofabronchopleuralfistulaina2yearoldchildwithdetachablecoils
AT hofbeckmichael interventionalclosureofabronchopleuralfistulaina2yearoldchildwithdetachablecoils
AT warmannstevenw interventionalclosureofabronchopleuralfistulaina2yearoldchildwithdetachablecoils
AT schaeferjuergenf interventionalclosureofabronchopleuralfistulaina2yearoldchildwithdetachablecoils
AT sieverdingludger interventionalclosureofabronchopleuralfistulaina2yearoldchildwithdetachablecoils