Successful Combination Treatment with Bronchial Occlusion Followed by Talc Pleurodesis for Refractory Bilateral Pneumothorax in a Patient with Interstitial Lung Disease

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Management of secondary spontaneous pneumothorax caused by interstitial lung disease is challenging because of the limited treatment options. This report describes a complicated case of secondary refractory pneumothorax in a patient with chronic obstructive pulmonary disease and interstitial lung disease, which was treated successfully by bronchial occlusion followed by chemical pleurodesis. A 75-year-old man was referred to our institution with right tension pneumothorax caused by combined pulmonary fibrosis and emphysema, which was treated with drainage. Subsequently, surgery was performed to treat a persistent air leak after the site was identified. However, left pneumothorax occurred postoperatively, followed by right pneumothorax recurrence. The culprit bronchi on both sides were filled using Endobronchial Watanabe Spigots. Consequently, the air leaks decreased but did not disappear completely. Chemical pleurodesis with talc was effective for the right-sided air leak. On the left side, three chemical pleurodesis procedures with additional bronchial occlusion were required to stop the air leak. The patient was discharged without any adverse events. Our experience suggests that bronchial occlusion followed by chemical pleurodesis could be effective for refractory pneumothorax in nonsurgical patients with interstitial lung disease.