PMC4501458_01
CT images before and after insertion of EWSs Upper, the left lung was collapsed by the 2nd episode of pneumothorax. The bullous lesions are indicated by arrowheads. Middle, full expansion of the left lung under the clamp of the chest tube was attained by endoscopic occlusion of bronchopleural fistula by endobronchial Watanabe spigots (EWS). Lower, image showing an EWS in the left B3 (arrow).
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Chest CT scans revealed left-sided pneumothorax (Fig. 1).
Time course after the insertion of the first EWS An EWS was inserted into the left B5 on day 1. Because of sustained air leaks, an additional EWS was inserted into the left B3, followed by left pleurodesis. The EWS in the left B5 was removed on day 7 to resolve obstructive pneumonia. Since air leaks disappeared, the chest drainage tube was removed on day14.
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Since operative intervention for pneumothorax was inapplicable because of the patient's poor respiratory reserve, endobronchial approach was performed (Fig. 2).
Chest X-ray images after the insertion of the second EWS New consolidations were observed in the left S3 and S5 on the day 7. The consolidation in the left S3 and S5 were decreased in size by antibiotics and the removal of the EWS in the left B5. Dyspnea was resolved and high fever disappeared.
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The chest X-ray image on the day 7 showed new consolidations in the left S3 and S5, suggesting diminished lung volume and obstructive pneumonia (Fig. 3).