Device Closure of a Persistent Air Leak After Lung Cancer Surgery

What happened, in summary

A 66-year-old woman who had never smoked was found to have a 9 mm acinar adenocarcinoma in the right lower lung during routine CT monitoring for systemic sclerosis. The tumor was classified T1N0M0. She underwent right lower lobectomy with mediastinal lymph-node removal and did not receive chemotherapy or radiation.

Two months later, she returned with shortness of breath, cough, a bubbling sensation in her chest, subcutaneous emphysema, and reduced breath sounds on the right. Thoracoscopic exploration found no recurrent cancer but confirmed a bronchopleural fistula at the right lower bronchus. Surgeons closed it with direct sutures and an intercostal muscle flap.

The fistula returned two months later. A second operation used a bovine pericardial patch, which initially sealed the leak, but symptoms recurred again three months later. Because she had undergone repeated thoracic operations and was taking chronic corticosteroids, another major surgery carried added risk. A multidisciplinary team instead placed a 7 mm atrial septal occluder device through combined bronchoscopic and fluoroscopic guidance. Autologous blood was applied to help the device adhere.

A small residual leak at two weeks was treated with biologic glue. Follow-up at two, six, and 12 months confirmed successful closure without device migration. She was asymptomatic and described a major recovery in mobility and quality of life.