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Rescue therapy using an endobronchial valve and digital air leak monitoring in Invasive Pulmonary Aspergillosis.

Tsim S, Paton L, Nicholson F, Blyth KG - Respir Med Case Rep (2014)

Bottom Line: In this case report, we describe the utilisation of two recently developed technologies for the successful management of a persistent air leak (PAL) in a critically ill patient in whom cardiothoracic surgical intervention was not possible.We report the case of a young leukaemic woman with a PAL complicating Invasive Pulmonary Aspergillosis (IPA), who was effectively managed using an Endobronchial Valve, supplemented by objective, digital air leak data provided by a Thopaz(®) device (Medela, Switzerland).

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Southern General Hospital, Glasgow G51 4TF, United Kingdom.

ABSTRACT
In this case report, we describe the utilisation of two recently developed technologies for the successful management of a persistent air leak (PAL) in a critically ill patient in whom cardiothoracic surgical intervention was not possible. We report the case of a young leukaemic woman with a PAL complicating Invasive Pulmonary Aspergillosis (IPA), who was effectively managed using an Endobronchial Valve, supplemented by objective, digital air leak data provided by a Thopaz(®) device (Medela, Switzerland).

No MeSH data available.


Related in: MedlinePlus

Selected axial (a) and coronal (b) images from a Thoracic Computed Tomography (CT) scan acquired on Day 96 in a patient with Invasive Pulmonary Aspergillosis (IPA). There is a left-sided tension pneumothorax and subcutaneous emphysema due to a large alveolar-pleural fistula resulting from rupture of a fungal mass lesion (*).
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fig2: Selected axial (a) and coronal (b) images from a Thoracic Computed Tomography (CT) scan acquired on Day 96 in a patient with Invasive Pulmonary Aspergillosis (IPA). There is a left-sided tension pneumothorax and subcutaneous emphysema due to a large alveolar-pleural fistula resulting from rupture of a fungal mass lesion (*).

Mentions: The patient's illness was complicated by a left-sided tension pneumothorax on Day 56. This prompted intercostal drain (ICD) insertion (12F, Rocket Medical®) and ICU admission. Despite appropriate antifungal and supportive therapies and a second ICD (16F, Rocket Medical®) the patient's lung failed to re-expand. Invasive mechanical ventilation was avoided and the patient managed with high-level oxygen supplementation. Digital thoracic drainage units (Thopaz®, Medela, Switzerland) demonstrated a consistent PAL in excess of 2000 ml/min, likely due to a ruptured fungal cavity in the lingular subsegment, which was demonstrated on a third CT scan on Day 96 (see Fig. 2). The patient was deemed unsuitable for thoracic surgical intervention due to excessive risk. Since EBVs are not a licensed treatment for PAL in the UK National Health Service, applications for funding and internal clinical governance board approval were submitted on compassionate grounds and approved.


Rescue therapy using an endobronchial valve and digital air leak monitoring in Invasive Pulmonary Aspergillosis.

Tsim S, Paton L, Nicholson F, Blyth KG - Respir Med Case Rep (2014)

Selected axial (a) and coronal (b) images from a Thoracic Computed Tomography (CT) scan acquired on Day 96 in a patient with Invasive Pulmonary Aspergillosis (IPA). There is a left-sided tension pneumothorax and subcutaneous emphysema due to a large alveolar-pleural fistula resulting from rupture of a fungal mass lesion (*).
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356032&req=5

fig2: Selected axial (a) and coronal (b) images from a Thoracic Computed Tomography (CT) scan acquired on Day 96 in a patient with Invasive Pulmonary Aspergillosis (IPA). There is a left-sided tension pneumothorax and subcutaneous emphysema due to a large alveolar-pleural fistula resulting from rupture of a fungal mass lesion (*).
Mentions: The patient's illness was complicated by a left-sided tension pneumothorax on Day 56. This prompted intercostal drain (ICD) insertion (12F, Rocket Medical®) and ICU admission. Despite appropriate antifungal and supportive therapies and a second ICD (16F, Rocket Medical®) the patient's lung failed to re-expand. Invasive mechanical ventilation was avoided and the patient managed with high-level oxygen supplementation. Digital thoracic drainage units (Thopaz®, Medela, Switzerland) demonstrated a consistent PAL in excess of 2000 ml/min, likely due to a ruptured fungal cavity in the lingular subsegment, which was demonstrated on a third CT scan on Day 96 (see Fig. 2). The patient was deemed unsuitable for thoracic surgical intervention due to excessive risk. Since EBVs are not a licensed treatment for PAL in the UK National Health Service, applications for funding and internal clinical governance board approval were submitted on compassionate grounds and approved.

Bottom Line: In this case report, we describe the utilisation of two recently developed technologies for the successful management of a persistent air leak (PAL) in a critically ill patient in whom cardiothoracic surgical intervention was not possible.We report the case of a young leukaemic woman with a PAL complicating Invasive Pulmonary Aspergillosis (IPA), who was effectively managed using an Endobronchial Valve, supplemented by objective, digital air leak data provided by a Thopaz(®) device (Medela, Switzerland).

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Southern General Hospital, Glasgow G51 4TF, United Kingdom.

ABSTRACT
In this case report, we describe the utilisation of two recently developed technologies for the successful management of a persistent air leak (PAL) in a critically ill patient in whom cardiothoracic surgical intervention was not possible. We report the case of a young leukaemic woman with a PAL complicating Invasive Pulmonary Aspergillosis (IPA), who was effectively managed using an Endobronchial Valve, supplemented by objective, digital air leak data provided by a Thopaz(®) device (Medela, Switzerland).

No MeSH data available.


Related in: MedlinePlus