"All things must pass" - Cutaneous migration of an endobronchial valve. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Lee, Michelle; Baranowski, Ralitsa; Gammon, David; Hargrave, Joanne; Waller, David
• Is Part Of: JRSM open. Volume 13:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: endobronchial valve -- complication -- persistent air leak -- bronchopleural fistula; Medicine -- Periodicals; Medicine -- Great Britain -- Periodicals; 610.5
• DOI: 10.1177/20542704221074148
• Languages: English
• ISSNs: 2054-2704

Abstract

Summary: The Zephyr (PulmonX Inc., Redwood, CA) endobronchial valve (EBV), predominantly designed for lung volume reduction in emphysema, can also be used to close a spontaneous or post-operative prolonged air leak (PAL). We describe a previously unreported complication of cutaneous migration of an EBV, inserted for management of a PAL from a postoperative bronchopleural fistula (BPF), in a 62-year-old male following a right upper lobe posterior-apical (S1, 2) segmentectomy. His PAL resulted in a chronic empyema which failed to respond to surgical debridement, anterior cavernostomy and pectoral myoplasty. Bronchoscopic closure of the air leak by EBV insertion resulted in clinical improvement but there was a residual chronic wound sinus through which the patient reported protrusion of a foreign body that was causing irritation. It was the EBV. We hypothesise that the BPF healed beneath the EBV causing it to dislodge but its route to the skin remains a mystery.