Kato Yuto, Okuda Miyuki, Fukuda Koji, Tanaka Nobuya, Nobuyama Seiichi
Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan.
Kansai Medical University Kori Hospital, 8-45, Korihondoricho, Neyagawa, Osaka, 572-8551, Japan.
J Med Case Rep. 2020 Dec 5;14(1):236. doi: 10.1186/s13256-020-02554-y.
Pneumothorax is defined as the presence of air or gas in the pleural cavity. Secondary pneumothorax usually occurs in patients with overt underlying lung disease, most commonly chronic obstructive pulmonary disease (COPD). Patients with poor lung function often suffer from pneumothorax with a persistent air leak. Various strategies have been employed in the treatment of such refractory pneumothorax. Bronchial occlusion with an Endobronchial Watanabe Spigot (EWS) (Novatech, Grasse, France) has been shown to be useful in treating prolonged bronchopleural fistulas. Although the effects of bronchial occlusion with EWS are known, refractory pneumothorax often involves multiple affected bronchi, and in some cases the affected bronchi cannot be easily identified. In addition, secondary pneumothorax associated with advanced lung cancer often prolongs the treatment of pneumothorax, which can significantly reduce patients' quality of life and prognosis.
We report a case of refractory pneumothorax where collateral ventilation was successfully treated by bronchial occlusion of the affected bronchi using multiple methods. In August 2019, an 80-year-old Japanese man with asthma and COPD overlap was admitted for exacerbation triggered by respiratory tract infection. During hospitalization, he presented with chest pain due to pneumothorax. Subsequently, a chest drain tube was inserted and pleurodesis was performed; however, the lung could not be sufficiently expanded and an air leak remained. Further investigation revealed a tumor suspicious for lung cancer at the entrance of the left upper lobe bronchus. Due to poor lung function, surgical treatments were deemed high risk. Therefore, we performed bronchial occlusion using the Endobronchial Watanabe Spigot (EWS). Because we could not determine the affected bronchi by computed tomography (CT), we located the affected bronchi by balloon occlusion test and bronchography with iopamidol. After occlusion, the air leak decreased but still persisted. Thus, we performed pleurodesis twice, and the air leak ceased completely.
Refractory secondary pneumothorax, which affected multiple bronchi and developed into collateral ventilation due to lung cancer, was treated successfully with bronchial occlusion and EWS. In cases where the affected bronchi cannot be determined by the balloon occlusion test, bronchography with iopamidol might be an effective treatment.
气胸被定义为胸膜腔内存在空气或气体。继发性气胸通常发生在有明显潜在肺部疾病的患者中，最常见的是慢性阻塞性肺疾病（COPD）。肺功能差的患者常因气胸而出现持续性漏气。针对这种难治性气胸已采用了多种治疗策略。使用支气管渡边栓子（EWS）（法国格拉斯的诺瓦泰克公司）进行支气管封堵已被证明对治疗长期支气管胸膜瘘有效。尽管EWS支气管封堵的效果是已知的，但难治性气胸通常涉及多个受累支气管，并且在某些情况下受累支气管不易识别。此外，与晚期肺癌相关的继发性气胸常常延长气胸的治疗时间，这会显著降低患者的生活质量和预后。
我们报告一例难治性气胸病例，通过多种方法对受累支气管进行支气管封堵成功治疗了侧支通气。2019年8月，一名患有哮喘和COPD重叠综合征的80岁日本男性因呼吸道感染引发病情加重入院。住院期间，他因气胸出现胸痛。随后，插入胸腔引流管并进行了胸膜固定术；然而，肺未能充分复张且仍有漏气。进一步检查发现左肺上叶支气管入口处有一个可疑肺癌肿瘤。由于肺功能差，手术治疗被认为风险很高。因此，我们使用支气管渡边栓子（EWS）进行支气管封堵。由于通过计算机断层扫描（CT）无法确定受累支气管，我们通过球囊封堵试验和碘帕醇支气管造影来定位受累支气管。封堵后，漏气减少但仍持续存在。因此，我们进行了两次胸膜固定术，漏气完全停止。
因肺癌累及多个支气管并发展为侧支通气的难治性继发性气胸，通过支气管封堵和EWS成功治愈。在通过球囊封堵试验无法确定受累支气管的情况下，碘帕醇支气管造影可能是一种有效的治疗方法。
