Tumor Rupture-induced Pleural Empyema with a Bronchopleural Fistula Treated with Bronchial Occlusion Using an Endobronchial Watanabe Spigot: A Case Report

Abstract

Primary lung cancer can rupture into the pleural cavity, leading to pleural empyema with bronchopleural fistula (BPF). Although early surgery is recommended for this condition, it can be challenging in patients for whom surgery is inappropriate. A 75-year-old man diagnosed with stage IVB non-small cell lung cancer was administered carboplatin and nab-paclitaxel. On day 11, the patient visited our hospital with a high fever. Chest radiography and computed tomography revealed a large left hydropneumothorax. Since hydropneumothorax occurred rapidly after chemotherapy, tumor rupture was considered. The fever subsided after antibiotic treatment and thoracic drainage; however, there were air leakage from the drainage tube and continuous discharge of pus from the BPF. Subsequently, bronchial occlusion using an endobronchial Watanabe spigot (EWS) was performed to arrest pus drainage from the bronchi. The tip of the EWS was grasped using forceps through a bronchoscope, and the plug was inserted into B¹⁺²c; the air leakage subsequently diminished. He was discharged on day 48, and there was no recurrence of pleural empyema after discharge. Pleural empyema with a BPF can occur secondary to tumor rupture into the pleural cavity, and bronchial occlusion using an EWS may be a treatment option.