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Endobronchial Valves for Treatment of Bronchopleural Fistula in Granulomatous Polyangitis: A Longitudinal Case Report

Venkatappa, Neethi MD*; Fadul, Rafid MD, MBA*; Raymond, Daniel MD; Cicenia, Joseph MD*; Gildea, Thomas R. MD, MS*

Journal of Bronchology & Interventional Pulmonology: April 2013 - Volume 20 - Issue 2 - p 186–188
doi: 10.1097/LBR.0b013e3182917513
Brief Reports

Bronchopleural fistula (BPF) is an abnormal communication between the bronchus and the pleural space, commonly occurring after pulmonary resection or due to a spontaneous pneumothorax secondary to an underlying lung disease. We present a case of BPF in the setting of granulomatous polyangitis treated with endobronchial valves (EBV) with a longitudinal follow-up. These 1-way valves allow air and mucus to exit the diseased segment of lung during expiration, but prevent the reentry of air upon inspiration. The targeted segment may undergo atelectasis, achieving nonsurgical lung volume reduction, and allowing the remaining lung to compensate for the loss of volume. The use of these valves has shown to decrease hospitalization, morbidity, and mortality in these patients. In this case, the patient endured a prolonged hospitalization (82 d) and was able to be discharged only 7 days after EBV placement. This facilitated engagement in a pulmonary rehabilitation program, increased physical activity, and ultimately resumption of normal activity for the patient. To our knowledge, this is the first case of EBV used to treat BPF in the setting of underlying granulomatous polyangitis. This underscores the point that in appropriate settings, EBVs can decrease morbidity and mortality, and significantly improve the quality of life.

*Cleveland Clinic Respiratory Institute

Cleveland Clinic Heart and Vascular Institute, Cleveland, OH

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Neethi Venkatappa, MD, Cleveland Clinic Respiratory Institute, 34 Whitbay Drive, West Orange, NJ 07052 (e-mail: neethi23@gmail.com).

Received December 13, 2012

Accepted January 29, 2013

© 2013 by Lippincott Williams & Wilkins.