Two Cases of Effective Treatment for Intractable Pneumothorax by Fibrin Glue Sealing Used with Thoracoscopy Under Local Anesthesia

Abstract

Background. We experienced 2 patients with poor lung function, who contracted intractable pneumothorax which was successfully treated by medical thoracoscopy under local anesthesia. Case Presentation. Case 1: A 64-year-old male patient with chronic interstitial pneumonia, treated with steroids and immunosuppressants, was diagnosed as pneumothorax combined with respiratory insufficiency. Pneumothorax was unchanged by conservative treatment with a chest drainage tube. Surgical treatment for intractable pneumothorax was estimated to involve a high risk of inducing acute exacerbation of the interstitial pneumonia. Case 2: A 62-year-old man with asbestos-related lung disease had been surgically treated for lung cancer twice, with extensive adhesion of his chest cavity revealed at the second surgery. He developed pyothorax and pneumothorax. His condition was unchanged with conservative treatment. Surgical treatment for intractable pneumothorax, for example a thoracotomy, was deemed too invasive. Results. Thoracoscopy was successfully performed in both cases to repair the ruptured lungs. We directly sealed the fistula with fibrin glue. Conclusion. Fibrin glue sealing by thoracoscopy under local anesthesia was useful and is a safe alternative to surgical treatment for intractable pneumothorax.