Management of bronchopleural fistula after microwave ablation of lung tumor: A case report and literature review

Several patients with lung tumors are not eligible for surgical treatment. For those patients, percutaneous lung tumor ablation serves as a minimally invasive alternative to address such tumors. Despite its effectiveness, notable complications associated with this procedure can occur, such as bronchopleural fistula (BPF), which can lead to severe consequences. Therefore, the comprehensive understanding of these complications is of great importance for their safe and efficient management. In the present study, the case of a 73-year-old man with BPF following microwave ablation (MWA) of lung tumor and its clinical management was reported. MWA was performed after the diagnosis of lung cancer. Following ablation, the patient received thoracic drainage and anti-infectious therapy. After verifying the presence of BPF, an endobronchial unidirectional valve (EBV) was implanted into the posterior basal segment bronchus (B10) of the right lower lobe using a bronchoscope. EBV can occlude fistula while allowing drainage of secretions and trapped air. The function contributes to reducing infections around the fistula and promoting healing. The air leakage was stopped five days after EBV implantation and the thoracic drainage tube was then removed. At 86 days after EBV implantation, the pulmonary infection disappeared, while chest computed tomography scan revealed that the pulmonary necrotic cavity was narrowed. EBV implantation may have a higher successful rate compared with other endoscopic treatments for BPF.