A case of persistent pneumothorax after bronchoscopic lung volume reduction successfully treated with video-assisted thoracic surgery without removal of endobronchial valves

With proper patient selection excluding collateral ventilation, bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) offers significant benefits but increases pneumothorax risk. Prioritized management of persistent pneumothorax post-BLVR remains unclear, with both EBV removal and video-assisted thoracic surgery (VATS) considered options. We report a 76-year-old man with severe emphysema who developed persistent pneumothorax and subcutaneous emphysema after left upper lobe BLVR. Following the patient's wishes, VATS was performed instead of EBV removal, resulting in a favorable outcome without delaying BLVR benefits. Depending upon the situation and patient wishes, prioritizing VATS over valve removal may be a reasonable strategy.