Successful Closure of Bronchopleural Fistula by Catheter-Assisted Intrabronchiolar Insertion of Microvascular Plug: A Case Report

Bronchopleural fistula (BPF) is a pathological connection between the bronchial tree and pleural space usually formed as a result of local or systemic illness affecting pulmonary or pleural tissue. It is associated with significant morbidity and prolonged stay in the hospital. We present the case of a 33-year-old male with multiple sclerosis with multiple co-morbidities who developed respiratory failure from pneumonia requiring mechanical ventilation (MV) and tracheostomy. He developed pneumothorax which remained persistent despite medical management and chest tube insertion suggesting BPF. A high-resolution CT chest confirmed BPF. The patient was not a suitable candidate for endoscopic or surgical repair. An occlusive microvascular plug was placed under fluoroscopy to close the leak. High-resolution chest CT confirmed resolution of air leak. The patient was subsequently discharged to a long-term ventilator facility for liberation of MV. Follow-up after discharge revealed successful liberation from the ventilator. BPF management is a challenge which requires multidisciplinary approach and careful assessment to choose the best approach for treatment especially in high-risk patients with a compromised pulmonary status. For patients who are not suitable candidates for surgical or endoscopic repair, radiologically guided application of an occluding device or sealants are attractive options.