Treatment of Intractable Pneumothorax with Emphysema Using Endobronchial Watanabe Spigots
A 53-year-old male patient underwent closed thoracostomy due to left pneumothorax at an outside hospital. Due to prolonged air leakage, he was transferred to Gangnam Severance Hospital for further evaluation and management. Chest computed tomography (CT) demonstrated diffuse lung emphysema with large bullae in both upper lobes and the superior segments of both lower lobes (). A pulmonary function test (PFT) revealed a forced vital capacity (FVC) of 2.69 L (69% of the normal range), a forced expiratory volume in one second (FEV1) of 1.65 L (56% of the normal range), a FEV1/FVC of 61%, and a diffusion capacity of the lung for carbon monoxide (DLCO) of 11.1 mL/mmHg/min (57% of the normal range). Arterial blood gas analysis showed a pH of 7.438, PO2 of 59.4 mmHg, and PCO2 of 33.2 mmHg in room air.\nWe concluded that a wedge resection of the ruptured bullae under general anesthesia would be a risky management option due to the patient's severe emphysema. Therefore, he underwent endobronchial occlusion with endobronchial Watanabe spigots (EWS; Novatech, Grasse, France) in the affected left subsegmental bronchi under fibrobronchoscopy.\nAir leakage ceased on the second day after insertion of the EWS. The chest tube was removed on the fourth day after air leakage ceased. He was discharged in good condition one day after removal of the chest tube and was followed up in Gangnam Severance Hospital outpatient clinic. The patient had no pneumothorax during a follow-up period of 7 months.