Bronchial Occlusion Using Nonwoven Fabric (Neoveil^®) Sewing EWS and a Guidewire for Intractable Secondary Pneumothorax

Abstract

Background. Secondary pneumothorax caused by chemotherapy for lung carcinoma is intractable, and treatment requires various devices depending on the case. Case. A man in his 70s was diagnosed with progressive lung adenocarcinoma and underwent chemotherapy (carboplatin+pemetrexed+bevacizumab). We treated him with pemetrexed as maintenance therapy, but the lung carcinoma grew larger. We changed the regimen of the chemotherapy to nivolumab. Ten days after the start of the chemotherapy, he came to our hospital with hemosputum, and we diagnosed right pneumothorax. We started drainage and talc pleurodesis therapy, but it was not effective. We performed bronchial occlusion with Endobronchial Watanabe Spigot (EWS) using two devices. (i) We sewed a polyglycolic acid nonwoven fabric on a large spigot, and (ii) we detained EWS in the intermediate bronchus using a guidewire. The air leak stopped, and we performed pleurodesis therapy with OK-432. Subsequently, his pneumothorax healed. Conclusion. The two devices that we used were beneficial for intractable secondary pneumothorax.