Successful occlusion of a bronchopleural fistula by a tracheostomy placeholder applied via interventional bronchoscopy in a patient with persistent thoracostomy

A 60 year-old woman undergoing mitral valve replacement experienced iatrogenic lung injury with subsequent empyema and need for pneumonectomy in 2007. A bronchopleural fistula and a thoracostomy persisted and could not be closed surgically. In 2014, a 8 mm septal occluder (Amplatzer, Abbot) was bronchoscopically placed in the bronchopleural fistula sufficiently sealing it. In 2024, the now enlarged fistula was occluded by a larger septal occluder (10 mm) which dislocated after a short period. With the open fistula (11 mm diameter) the patient suffered from significant hypercapnia and inability to speak. Subsequently a spigot (Animus Beyford Trading, 10-12 mm) was positioned in the fistula but also dislocated two days later. In a combined bronchoscopy/thoracoscopy-procedure in general anaesthesia a silicone tracheostomy placeholder (Tracoe button plus, 11 mm) including an external plugging button was placed in the fistula with its tracheal flange positioned in the bronchus stump. The external retaining plate was tied up manually in the thoracic cavity. After the procedure, the patient regained speaking ability and showed improved spontaneous ventilation. In summary, the use of a tracheostomy placeholder turned out to be a successful therapeutic option as an individual solution in a patient with bronchopleural fistula and persistent thoracostomy. <fig><object-id>erj;64/suppl_68/PA2545/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>