Management of alveolar-pleural fistula secondary to invasive pulmonary aspergillosis with bronchial occlusion using a combination of Endobronchial Watanabe Spigot and N-butyl-2-cyanoacrylate: A case report

Abstract

Alveolar-pleural fistulas that do not improve with thoracic drainage can be conservatively treated via endobronchial occlusion and pleurodesis, among other options. However, for inoperable cases, the treatment strategy to be followed, in the event that conventional conservative management fails, is unclear. Herein, we report a case of alveolar-pleural fistula managed by bronchial occlusion using a combination of Endobronchial Watanabe Spigot (EWS) and N-butyl-2-cyanoacrylate (NBCA). A 79-year-old man on prednisolone for interstitial pneumonia with autoimmune features was diagnosed with invasive pulmonary aspergillosis and Aspergillus pyothorax infection. He was administered voriconazole; however, a pneumothorax developed and did not improve with thoracic drainage. Bronchial occlusion with EWS failed due to spigot migration. However, a combination of EWS with NBCA could control the alveolar-pleural fistula. Thus, an EWS and NBCA combination may help prevent EWS migration, providing another option for patients who are unfit for surgery.