Abstract
Bronchopleural fistula is an increasingly frequent complication, difficult to manage and with increased morbidity and mortality, especially in the pediatric population. Surgical treatment is migrating to a multidisciplinary percutaneous approach where pneumothorax drainage, fibrinolytic management, and chemical pleurodesis can be offered. We present a case of an infant with persistent bronchopleural fistula difficult to manage after surgical treatment and chest tube placement, where percutaneous treatment offers good results. A review of the evidence that describes and supports each of the decisions made in the management of bronchopleural fistula is performed.
References
Lim, D. Y., Wang, M., Chokkappan, K., Lee, K. A., Leong, S., Ng, K. S., & Too, C. W. (2022). Percutaneous Treatments for Persistent Bronchopleural and Alveolar-Pleural Fistulae. Journal of vascular and interventional radiology : JVIR, 33(4), 410–415.e1. https://doi.org/10.1016/j.jvir.2021.12.018
Ojha S, Sen G, Bansal R, et al. Persistent air leak (bronchopleural fistula) in neonates. J Pediatr Neonatal Care. 2021;11(2):35?38. DOI: 10.15406/jpnc.2021.11.00441
Kenneth K. Sakata, Janani S. Reisenauer, Ryan M. Kern, John J. Mullon, Persistent air leak - review, Respiratory Medicine, Volume 137, 2018, Pages 213-218, ISSN 0954-6111, https://doi.org/10.1016/j.rmed.2018.03.017.
Amelio, G. S., Colnaghi, M., Gulden, S., Raffaeli, G., Cortesi, V., Amodeo, I., Cavallaro, G., Mosca, F., & Ghirardello, S. (2021). Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant. Children (Basel, Switzerland), 8(12), 1208. https://doi.org/10.3390/children8121208
Hawkins JA, Scaife ES, Hillman ND, Feola GP. Current treatment of pediatric empyema. Semin Thorac Cardiovasc Surg. 2004 Fall;16(3):196-200. doi: 10.1053/j.semtcvs.2004.08.004. PMID: 15619185.
Tokuda Y, Matsushima D, Stein GH, Miyagi S. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest. 2006 Mar;129(3):783-90. doi: 10.1378/chest.129.3.783. PMID: 16537882.
Hanson SJ, Havens PL, Simpson PM, Nugent ML, Wells RG. Intrapleural alteplase decreases parapneumonic effusion volume in children more than saline irrigation. Pediatr Pulmonol. 2015 Dec;50(12):1328-35. doi: 10.1002/ppul.23184. Epub 2015 Apr 2. PMID: 25847131.