Three Cases of Intractable Pneumothorax Treated Successfully with Bronchial Occlusion Using Endobronchial Watanabe Spigots and Coagulation Factor XIII

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Purpose. We investigated the usefulness of endobronchial Watanabe spigots (EWS) and/or coagulation factor XIII concentrate for intractable pneumothorax with pulmonary emphysema. We used EWS and/or coagulation factor XIII concentrate together for 3 intractable pneumothorax cases with pulmonary emphysema suffering from prolonged pulmonary air leakage. Methods. Despite thoracic tube drainage for more than 2 weeks, the pulmonary air leakage continued. Bronchial occlusion using EWS was then performed. To obtain bronchial occlusion, the affected bronchi were determined by the balloon catheter test or with other clinical methods. If after using EWS bronchial occlusion minor air leakage continued, coagulation factor XIII concentrate was given intravenously for 5 days. Results. In the first case, we treated it with pleurodesis and coagulation factor XIII and did not perform bronchial occlusion. In the other 2 cases, we performed bronchial occlusion using EWS followed by the administration of coagulation factor XIII concentrate. In all 3 cases, the prolonged air leakage was stopped. On chest X-ray films, the collapsed lungs re-expanded and chest tubes could be removed after these treatments. EWS and/or administration of coagulation factor XIII concentrate might be an effective and noninvasive treatment for patients with intractable pneumothorax followed by prolonged air leakage.
2010-05-25