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Bronchoscopic ethanolamine injection therapy in patients with persistent air leak from chest tube drainage.

Lim AL, Kim CH, Hwang YI, Lee CY, Choi JH, Shin T, Park YB, Jang SH, Park SM, Kim DG, Lee MG, Hyun IG, Jung KS, Shin HS - Tuberc Respir Dis (Seoul) (2012)

Bottom Line: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula.Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events.With success, the time from the procedure to discharge was about 3 days (median).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.

Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.

Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).

Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

No MeSH data available.


Related in: MedlinePlus

Case 9. A 56-year-old male patient who had empyema due to broncho-pleural fistula. Hydropneumothorax (A), 10 and 13 days after ethanolamine injection therapy (B, C).
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Figure 2: Case 9. A 56-year-old male patient who had empyema due to broncho-pleural fistula. Hydropneumothorax (A), 10 and 13 days after ethanolamine injection therapy (B, C).

Mentions: In Figure 2 (case 9), a 56-year-old male patient who had no specific underlying lung disease visited the hospital due to fever and chest pain. After right hydropneumothorax was observed on radiography, the patient immediately underwent chest tube drainage. As a bronchopleural fistula was suspected on a chest CT, bronchoscopy was conducted prior to the surgical treatment. As a result, a small fistula was observed in the orifice of right middle lobe bronchus, from which pus-like foamy secretion was discharged. The patient was diagnosed with empyema caused by a bronchopleural fistula, and the air leak from the chest tube was expected to be halted if this fistula was closed. Luckily, the air leak was halted after ethanolamine injection therapy, and subsequently, the chest tube was removed from the patient. Takaoka et al.15 reproted that local injection of an ethanolamine was effective in occluding central bronchopleural fistula with a diameter of 1 mm or less because the swollen mucosa epithelium due to regional edema induced the mechanical occlusion of the fistula. That is, if an ethanolamine is injected to the mucosa around the fistula orifice, increased blood flow, fibrin disintegration and tissue granulation are formed as the time went by, and 2 months later, connective tissue and fibrin were completely covered over with epithelial tissue2,5. Subsequently, the fistula was covered with fibrous scarring. However, in the case of fistula with a diameter of 3 mm or more, it is difficult to close because the patient would expectorate the fibrin plug by local injection of ethanolamine solution during coughing even if it closes the fistula initially. It has been reported that the mortality is high due to aspiration pneumonia, pyothorax, and sepsis if a surgical treatment is conducted in patients with bronchopleural fistula. Hollaus et al.16 reported that postoperative mortality was 31%. Therefore, in the treatment of bronchopleural fistula, a bronchoscopic treatment may be an alternative prior to the determination of surgical treatment.


Bronchoscopic ethanolamine injection therapy in patients with persistent air leak from chest tube drainage.

Lim AL, Kim CH, Hwang YI, Lee CY, Choi JH, Shin T, Park YB, Jang SH, Park SM, Kim DG, Lee MG, Hyun IG, Jung KS, Shin HS - Tuberc Respir Dis (Seoul) (2012)

Case 9. A 56-year-old male patient who had empyema due to broncho-pleural fistula. Hydropneumothorax (A), 10 and 13 days after ethanolamine injection therapy (B, C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3475465&req=5

Figure 2: Case 9. A 56-year-old male patient who had empyema due to broncho-pleural fistula. Hydropneumothorax (A), 10 and 13 days after ethanolamine injection therapy (B, C).
Mentions: In Figure 2 (case 9), a 56-year-old male patient who had no specific underlying lung disease visited the hospital due to fever and chest pain. After right hydropneumothorax was observed on radiography, the patient immediately underwent chest tube drainage. As a bronchopleural fistula was suspected on a chest CT, bronchoscopy was conducted prior to the surgical treatment. As a result, a small fistula was observed in the orifice of right middle lobe bronchus, from which pus-like foamy secretion was discharged. The patient was diagnosed with empyema caused by a bronchopleural fistula, and the air leak from the chest tube was expected to be halted if this fistula was closed. Luckily, the air leak was halted after ethanolamine injection therapy, and subsequently, the chest tube was removed from the patient. Takaoka et al.15 reproted that local injection of an ethanolamine was effective in occluding central bronchopleural fistula with a diameter of 1 mm or less because the swollen mucosa epithelium due to regional edema induced the mechanical occlusion of the fistula. That is, if an ethanolamine is injected to the mucosa around the fistula orifice, increased blood flow, fibrin disintegration and tissue granulation are formed as the time went by, and 2 months later, connective tissue and fibrin were completely covered over with epithelial tissue2,5. Subsequently, the fistula was covered with fibrous scarring. However, in the case of fistula with a diameter of 3 mm or more, it is difficult to close because the patient would expectorate the fibrin plug by local injection of ethanolamine solution during coughing even if it closes the fistula initially. It has been reported that the mortality is high due to aspiration pneumonia, pyothorax, and sepsis if a surgical treatment is conducted in patients with bronchopleural fistula. Hollaus et al.16 reported that postoperative mortality was 31%. Therefore, in the treatment of bronchopleural fistula, a bronchoscopic treatment may be an alternative prior to the determination of surgical treatment.

Bottom Line: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula.Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events.With success, the time from the procedure to discharge was about 3 days (median).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.

Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.

Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).

Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

No MeSH data available.


Related in: MedlinePlus