Abstract
A 81-year-old man consulted his home doctor because of sudden dyspnea, and pneumothorax was diagnosed. As the collapsed left lung reexpanded, a mass shadow became apparent in the left middle lung field. After admission to our hospital, squamous cell carcinoma was diagnosed but he was evaluated as inoperable because of poor pulmonary function despite the fact that it was early stage lung cancer. Several days after admission, pneumothorax reccurred and tube thoracostomy was performed. Because of continuous massive air leakage in spite of two attempts at pleurodesis with OK-432, we tried bronchofiberscopic bronchial obstruction therapy (BBOT). Since obstruction of the lingular branch with a balloon catheter resulted in disappearance of the air leakage, this bronchus was judged to be responsible for the leakage of air. Some pieces of oxidized cellulose cotton were placed in the lingular bronchus using a fiberoptic bronchoscope. Immediately after the complete obstruction of the bronchus, the air leakage halted. Pleurodesis with OK-432 was once again tried successfully and the intercostal tube was removed on the fifth day after BBOT. In 8 cases treated successfully by BBOT in our institute, there has been no recurrence of pneumothorax after BBOT. Therefore, we recommend this therapy in cases of pneumothorax with continuous air leakage, before considering surgical treatment.
