Successful use of blood pleurodesis to resolve an iatrogenic persistent pneumothorax in a patient with pulmonary tuberculosis

Abstract

A Somali patient with previous tuberculosis presented clinically unwell with features consistent with a right-sided pleural effusion. Subsequent investigations confirmed a community-acquired pneumonia and relapse of pulmonary tuberculosis, with a drug resistant strain isolated. The patient developed a large left-sided iatrogenic pneumothorax, which recurred and failed to resolve despite the successful insertion of both Seldinger and surgical chest drains, and the patient remained clinically unstable on the intensive care unit. A blood pleurodesis was successfully used to provide resolution of this patient's previously persistent pneumothorax, which has resulted in stabilisation of the patient and no further pneumothoraces have occurred subsequently. The authors therefore highlight the use of a blood pleurodesis as a little used technique that may provide a valuable tool to other clinicians in similar cases.

Novel Insights from Clinical Practice Autologous Blood Patch Pleurodesis and Endobronchial Valves for Management of Persistent Air Leaks in Two Cases of Tuberculosis

“…Most evidence for the efficacy of ABPP is early after surgical lung resection. While its use has been described in the setting of active infection, the evidence is limited [9][10][11]18]. ABPP can also be utilized despite areas of pleural nonapposition [19].…”

“…EBVs are placed with a flexible bronchoscope in segmental or subsegmental bronchi to limit airflow to distal areas of the lung, while allowing mucus egress and airflow in proximal areas [8] permitting the BPF to heal with subsequent valve removal. Autologous blood patch pleurodesis (ABPP) has been used to address both secondary spontaneous pneumothoraces (SSPs) and PALs mainly after active pulmonary infection [9][10][11][12]. A portion of the patient's own blood is injected into their pleural space via a chest tube.…”