Two Cases of a Fistula Empyema in Which Surgery Was Avoided by Bronchial Embolization Using an Endobronchial Watanabe Spigot and Drainage with a Digitalized Chest Drainage System (Thopaz+™)

Abstract

Background. A fistula empyema often requires surgery, such as fenestration, but there are reports that surgery can be avoided with bronchial embolization. Case 1. A 76-year-old man was admitted to our hospital due to increasing dyspnea of several days' duration. He was diagnosed with a fistula empyema and treated with chest tube drainage and antibiotics. Because air leakage persisted, bronchial embolization using an Endobronchial Watanabe Spigot (EWS) was performed on the 8th day of hospitalization. The air leakage resolved, and on the 11th hospital day, suction with a digitalized chest drainage system (Thopaz+™) was started. The thoracic cavity with the empyema gradually contracted, and the drain was removed on the 19th hospital day. Case 2. A 47-year-old man was admitted to our hospital for the evaluation of a cough and pleural effusion. He was diagnosed with a fistula empyema and treated with chest tube drainage and antibiotics. Because air leakage persisted, as in Case 1, bronchial embolization using an EWS was performed on the 4th day of hospitalization. The air leakage resolved, and on the 5th hospital day, suction with a digitalized chest drainage system was started. The thoracic cavity with the empyema gradually contracted, and the drain was removed on the 18th hospital day. Conclusion. We successfully managed 2 patients in whom surgery was avoided by bronchial embolization using an EWS, followed by stable negative-pressure drainage using a digitalized chest drainage system.