Bronchoscopic Localization of a Post‐Surgical Persistent Air Leak Facilitating Successful Treatment With a Hybrid Imaging‐Guided Percutaneous Sealing of Fistula and Autologous Blood Patch Technique

ABSTRACT

Post‐surgical persistent air leak (PAL) poses significant management challenges in patients with high surgical risk and complex anatomy. A 58‐year‐old female with advanced thymoma underwent extensive thoracic resection and developed PAL refractory to conservative management with pleural drain insertion. Chest Computed Tomography (CT) suggested a possible broncho‐pleural fistula at the left lower lobe superior segment. Sequential bronchoscopic balloon occlusion under general anaesthesia localized the fistula to the LB6 lateral subsegment with the aid of a digital chest drain system. This was confirmed by methylene blue instillation via bronchoscopy and observation of colour change in the pleural drain fluid. Interventional radiology (IR) subsequently performed CT‐fluoroscopy guided percutaneous sealing of fistula using Histoacryl‐lipiodol mixture, followed by autologous blood and thrombin instillation via the pleural drain, resulting in obliteration of fistula and complete resolution of PAL. We highlight a unique case of multi‐disciplinary collaboration between Pulmonology and IR to successfully treat PAL via a combination of minimally invasive techniques.