Post-thoracotomy Fibrin Glue Pleurodesis for Persisting Air Leaks: A Case Study

Persistent air leaks (PALs) secondary to residual pleural spaces (RPSs) are the most common complication post-thoracotomy and positively correlate with the length of hospital stay. Among numerous treatment strategies, fibrin glue pleurodesis has the benefit of filling the RPS and can be used multiple times without anesthesia or sedation. A 71-year-old male presented with a 1 cm positron emission tomography positive nodule in the right upper lobe, who had undergone prior thoracotomy for a lung mass in 2011. Thoracotomy with wedge resection was performed with findings of diffuse lung parenchymal scarring and severe inflammatory adhesions requiring complete three-lobe decortication. Pneumothorax with a large air leak was noted postoperatively. Despite aggressive pulmonary toilet strategies, the persisting pneumothorax on postoperative day (POD) 3 required therapeutic bronchoscopy, rib resection, oversewing air leaks, topical sealant application, and three chest tube placements. Residual apical pneumothorax with PALs persisted postoperatively. Eight fibrin glue pleurodesis via a chest tube was completed over eight days, resulting in the cessation of air leak and resolution of apical pneumothorax. Fibrin glue served as a suitable pleurodesis agent in this case by filling the RPS and sealing air leaks. The body resorbs fibrin glue over time and can be performed serially to fill the RPS and avoid further surgery.