Bronchoscopic management of bronchopleural fistula due to COVID-19 a nonsurgical option

ABSTRACT

Background: COVID-19 has become a dreadful pandemic. One of the important complication is the development of pneumothorax/ pneumomediastinum which gets further complicated by bronchopleural fistula. Case Study A 44year male patient with severe COVID pneumonia developed Left sided pneumothorax and treated conservatively with ICD and negative suctioning for 2 months and referred to us with persistent pneumothorax with BPF. As patient was unfit for surgery, bronchoscopic management was planned. With flexible bronchoscope, 6F Fogarty balloon was passed and inflated, leak site was identified in left upper lobe upper division. A Watanabe spigot size 5 was deposited at the opening of upper division and manipulated to apical segment. Other small openings were sealed with cyanoacrylate glue and autologous blood patch. After procedure negative suction was reapplied. Repeat Xray showed resolution of pneumothorax. Pleurodesis was done with talc slurry, post pleurodesis showed no pneumothorax and ICD was removed. Patient was discharged, follow up X ray after 4weeks showed no evidence of pneumothorax. Discussion: In most cases of BPF, leak seals after tube thoracostomy, only 3-5% will continue to have persistent leak. For medically inoperable cases, bronchoscopic balloon occlusion of site and subsequent injection with fibrin glue, liquid bioadhesive or blood patch can be done. For large leak;Amplatzer device, stents, spigots, coils are used. Conclusion: Bronchoscopic treatment can work well for a medically inoperable, complicated pneumothorax in COVID-19 disease.