Open AccessTransbronchial Occlusion of a Malignant Bronchopleural Fistula With Cyanoacrylate Glue
Author(s) -
Takashi Iwata,
Shinichiro Iida,
Shoji Hanada,
Hidenari Inoue,
Yuka Morikawa,
Kazushige Inoue,
Yasuhiko Kobayashi,
Takuya Miura
Publication year - 2011
Publication title -
journal of bronchology and interventional pulmonology
Language(s) - English
Resource type - Journals
eISSN - 1944-6586
pISSN - 1948-8270
DOI - 10.1097/lbr.0b013e3182180d9c
Subject(s) - medicine , bronchopleural fistula , lipiodol , pleurodesis , chest radiograph , pneumothorax , surgery , radiology , catheter , empyema , thoracostomy , mediastinitis , fistula , pleural effusion , pneumonectomy , radiography , embolization , lung
A 73-year-old man who had undergone surgery for lingual cancer, followed by radiation therapy and chemotherapy, presented with severe dyspnea. A chest radiograph revealed a left tension pneumothorax. An immediate tube thoracostomy alleviated his dyspnea. A chest computed tomography scan showed multiple large cystic tumors in both lungs. Squamous cell carcinoma was cytologically proven in the pleural effusion. A malignant bronchopleural fistula due to a metastatic pulmonary tumor was diagnosed. Surgical interventions were tried twice. However, air leakage occurred when the rapidly recurring tumor caused bilateral pneumothoraces. Thus, bronchoscopic closure was conducted. A flexible video bronchoscope and a thin catheter were inserted into the targeted left bronchiolus. The lumen of the catheter was filled with water. Cyanoacrylate glue and lipiodol were mixed in 2 syringes, and the mixture was slowly injected and then flushed with water. As soon as the lipiodol accumulation was visualized by radiograph fluoroscopy, the air leakage stopped. Pleurodesis with the intrathoracic administration of OK-432 was added to both pleural cavities, and the left and right chest tubes were removed on the third and fifth days, respectively. The patient was discharged the following day. However, he died of the disease a month later.