Endoscopic bronchial occlusion with silicone spigots under virtual bronchoscopic navigation

Area of Science:

• Pulmonology
• Radiology
• Interventional Bronchoscopy

Background:

• A 68-year-old female patient presented with interstitial lung disease secondary to dermatomyositis and systemic scleroderma.
• The patient developed a persistent left pneumothorax with a continuous air leak despite conventional management, including chest drainage and pleurodesis.

Observation:

• Chest computed tomography (CT) revealed a cavitary lesion in the left upper division, suspected as the source of the air leak.
• Virtual bronchoscopic navigation (VBN) was employed, utilizing CT data to create detailed 3D reconstructions of the bronchial tree.

Findings:

• Bronchial occlusion was performed using Endobronchial Watanabe Spigots (EWSs) guided by VBN.
• The insertion of two medium-sized EWSs into the left B1+2a and B1+2b segments immediately halted the air leak.
• The patient experienced no procedure-related adverse events, and chest tubes were successfully removed.

Implications:

• This case highlights the utility of VBN in enhancing the precision of bronchial occlusion procedures.
• EWSs represent an effective treatment option for managing persistent air leaks, particularly in complex cases.
• The integration of VBN and EWSs offers a promising minimally invasive approach for treating refractory pneumothorax.