Correct!
5. All of the above
Bronchopleural fistulas can occur with trauma, pulmonary resection or from necrotic lung tissue during treatment for lung cancer or infection. A balloon-tipped Fogarty catheter can be inserted into the bronchus and when the balloon is inflated can result in a reduction in the pneumothorax identifying the bronchus where the fistula originates. That was done in this case the identified the right upper lobe as the source of the fistula. Endobronchial valves for compassionate use may be considered. These are valves that allow air to escape from the pleural space into the bronchi during exhalation but are closed during inspiration. A valve was placed in this patient and resulted in a dramatic reduction in the size of the pneumothorax (Figure 3).
Figure 3. Panel A: original chest radiograph. Panel B: repeat chest radiograph about 1 week after endobronchial valve insertion.
In a recent series of 40 patients with persistent air leaks, 93% experienced improvement and 48% complete resolution with endobronchial valves (1). In another series of 14 patients, resolution occurred in 56% (2). Our patient was eventually able to be discharged from the hospital.
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