Percutaneous fibrin injection for the successful closure of an iatrogenic bronchopleural fistula following percutaneous lung biopsy

Percutaneous fibrin injection for the successful closure of an iatrogenic bronchopleural fistula following percutaneous lung biopsy

Sophia M. Foroushani, MD^1,2, Jessica Shi, MD^1,2, Ducksoo Kim MD^3,4, Gentian Kristo, MD, MPH, FACS^1,5.

¹Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; ²Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, MA, USA; ³Department of Interventional Radiology, Veterans Affairs Boston Healthcare System, Boston, MA, USA; ⁴Department of Interventional Radiology, Boston Medical Center, Boston University Medical School, Boston, MA, USA; ⁵Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Background: Bronchopleural fistula (BPF) following percutaneous lung mass biopsy is a very rare but challenging complication. We describe percutaneous fibrin injection as safe and successful in the treatment of BPF. Additionally, we present a thorough literature review of the reported treatment options of iatrogenic BPF.

Summary: A 68-year-old man with a lung cancer, COPD, and multiple other comorbidities underwent an image-guided percutaneous biopsy of an enlarging right-upper lobe lung nodule that was complicated by a large iatrogenic right-sided pneumothorax requiring an image-guided placement of a drainage catheter. Four days after the catheter placement, he was diagnosed with a BPF after developing a continuous air leak, pneumomediastinum, and extensive subcutaneous emphysema. Because patient wished to avoid placement of a chest tube, endobronchial interventions, or any other invasive procedures for management of his BPF, he underwent an image-guided, percutaneous fistula closure by injection of fibrin sealant in the fistula tract.

Conclusion: BPF represents a significant challenge requiring a multidisciplinary approach. Percutaneous fibrin injection in the fistula tract represents a less invasive option for patients who have small fistulae, are not operative candidates, or wish to avoid the morbidity of a major surgical interventions.

Disclosure Statement: The authors have no conflicts of interest or financial disclosures to declare.

Keywords: bronchopleural fistula; percutaneous treatment; fibrin sealant

Free Full-text PDF

How to cite this article:

Sophia M. Foroushani, Jessica Shi, Ducksoo Kim, Gentian Kristo.Percutaneous fibrin injection for the successful closure of an iatrogenic bronchopleural fistula following percutaneous lung biopsy. International Journal of Case Reports, 2022, 6:279. DOI: 10.28933/ijcr-2022-07-1305smf

References:

1. Deschamps C, Bernard A, Nichols FC III, et al. Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence. Ann Thorac Surg 2001;72:243– 8.
2. Asamura H, Naruke T, Tsuchiya R, et al. Bronchopleural fistulas associated with lung cancer operations. J Thorac Cardiovasc Surg 1992;104:1456–64.
3. Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest 2005;128[6]:3955–3965.
4. John SK, Jacob S, Piskorowski T. Bronchocutaneous fistula after chesttube placement: a rare complication of tube thoracostomy. Heart Lung 2005;34:279–281.
5. Bui JT, Gaba RC, Knuttinen MG, et al. Microwave lung ablation complicated by bronchocutaneous fistula: case report and literature review. Semin Intervent Radiol 2011;28:152–155.
6. Mehta RH, Hoag J, Borah A, Abramian E. Closure of a bronchopleural fistula complicating cryoprobe biopsy of the lung. Respirol Case Rep. 2018 Apr 6;6[5]:e00319.
7. Shrager JB, DeCamp MM, Murthy SC. Intraoperative and postoperative management of air leaks in patients with emphysema. Thoracic Surgery Clinics, 2009.19: 223–31.
8. de Perrot M, Licker M, Robert J, et al. Incidence, Risk Factors, and Management of Bronchopleural Fistulae after Pneumonectomy. Scand Cardiovasc J 1999;33[3]:171-174.
9. Cerfolio RJ. The incidence, etiology, and prevention of postresectional bronchopleural fistula. Semin Throac Cardiovasc Surg 2001;13[1]:3-7.
10. Khankan A, Sirhan S, Aris F. Common Complications of Nonvascular Percutaneous Thoracic Interventions: Diagnosis and Management. Semin Intervent Radiol 2015;32: 174-181.
11. Roberts RM, Dhesi B, Amerasekera S, et al. Bronchocutaneous Fistula without Pneumothorax after Intercostal Chest Drain Placement. Am J Respir Crit Care Med 2016;194[6]: 765-766.
12. Okuda M, Go T, Yokomise H. Risk factor of bronchopleural fistula after general thoracic surgery: review article. Gen Thorac Cardiovasc Surg 2017;65:679-685.
13. Webb A, Angus D, Finfer S, et al. Management of pneumothorax and bronchial fistulae. In: Oxford Textbook of Critical Care, 2nd Edition. Oxford University Press; 2016.
14. Hankins JR, Miller JE, Attar S, et al. Bronchopleural Fistula. Thirteen year experience with 77 cases. J Thorac Cardiovasc Surg; 1978;76[6]: 755-762.
15. West D, Togo A, Kirb AJB. Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula and effective alternative to repeat thoracotomy? Interact Cardiovasc Thorac Surg 2007;6[4]:547-550.
16. Wain JC. Management of late postpneumonectomy empyema and bronchopleural fistula. Chest Surg Clin N Am 1996;6[3]:529-541.
17. Guar P, Dunne R, Colson YL, et al. Bronchopleural fistula and the role of contemporary imaging. J Thorac Cardiovasc Surg 2014;148[1]:341-347.
18. Hollaus PH, Lax F, el-Nashef BB, et al. Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg 1997;63:1391-1396.
19. Tsubakimoto M, Murayama S, Iraha R, et al. Can Peripheral Bronchopleural Fistula Demonstrated on Computed Tomography be Treated Conservatively? A Retrospective Analysis. J Comput Assist Tomogr 2016;40[1]: 86-90.
20. Sarkar P, Chandak T, Shah R, et al. Diagnosis and management bronchopleural fistula. Indian J Chest Dis Allied Sci 2010;52[2]: 97-104.
21. Bribriesco A, Patterson GA. Management of Postpneumonectomy Bronchopleural Fistula. Thoracic Surgery Clinics 2018;28[3]:323-335.
22. Travaline JM, McKenna RJ, De Giacomo T, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest 2009;136:355-360.
23. Gillespie CT, Sterman DH, Cerfolio RJ, et al. Endobronchial valve treatment for prolonged air leaks of the lung: a case series. Annals of Thoracic Surgery 2001;91:270-273.
24. Snell GI, Holsworth L, Fowler S, et al. Occlusion of a Broncho-Cutaneous Fistula with Endobronchial One-Way Valves. Ann Thorac Surg 2005;80:1930-2.
25. Jain R, Baijal SS, Phadke RV, et al. Endobronchial Closure of a Bronchopleural Cutaneous Fistula Using Angiography Catheters. AJR 2000;175:1646-1648.
26. Kapicibasi HO, Alpay AL, Baysungur SV. Endobronchial treatment for bronchopleural fistula after lung resection. Izmire Gogus Hastanesi Dergisi 2020;34[1]:24-34.
27. Lim DY, Wang M, Chokkappan K, et al. Percutaneous Treatments for Persistent Bronchopleural Fistula and Alveolar-Pleural Fistulae. J Vasc Interv Radiol 2022;33:410-415.