Fresh frozen plasma pleurodesis for bronchopleural fistula following secondary spontaneous pneumothorax due to ruptured emphysematous bullae in a high-risk elderly COPD patient

IF 0.7 Q4 RESPIRATORY SYSTEM

Respiratory Medicine Case Reports Pub Date : 2026-01-01 Epub Date: 2026-08-11 DOI:10.1016/j.rmcr.2026.102476

Afroza Akhter, Shaila Sharmin, Tanima Biswas

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Abstract

Introduction

Persistent air leak (PAL) secondary to bronchopleural fistula (BPF) is a serious complication of secondary spontaneous pneumothorax (SSP) resulting from ruptured emphysematous bullae in patients with chronic obstructive pulmonary disease (COPD). Management is particularly challenging in elderly high-risk individuals who are unsuitable for surgical intervention. Fresh frozen plasma (FFP), containing fibrinogen and coagulation factors, may act as a biological sealant and facilitate pleural closure.

Case report

A 76-year-old man, a former smoker with COPD and multiple comorbidities presented with severe acute dyspnea and persistent cough due to right-sided pneumothorax with lung collapse. A water-sealed intercostal chest drain was inserted; although respiratory distress improved, a persistent air leak continued. High-resolution computed tomography confirmed right-sided pneumothorax with associated lung atelectasis and multiple emphysematous bullae. Given the high surgical risk, a total of three units of ABO-compatible fresh frozen plasma (FFP) were administered intrapleurally through the existing chest tube on alternate days. A gradual reduction in air leak was observed, with complete cessation by day 17. The chest tube was removed on day 20 following radiographic confirmation of full lung re-expansion. At 6-month follow-up, the patient remained clinically stable without recurrence of pneumothorax or the need for further pleural intervention.

Conclusion

Intrapleural FFP pleurodesis may represent a safe, feasible, and cost-effective alternative for managing persistent air leak in high-risk elderly COPD patients when surgical options are contraindicated. Complete resolution may require a prolonged course; however, the favorable outcome without complications reinforces the value of a carefully selected management strategy in this challenging clinical context.

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新鲜冷冻血浆胸膜切除术治疗老年COPD高危患者肺气肿大泡破裂继发自发性气胸后支气管胸膜瘘1例

慢性阻塞性肺疾病（COPD）患者继发于支气管胸膜瘘（BPF）的持续性空气泄漏（PAL）是由肺气肿大泡破裂引起的继发自发性气胸（SSP）的严重并发症。管理是特别具有挑战性的老年高危人群谁是不适合手术干预。新鲜冷冻血浆（FFP）含有纤维蛋白原和凝血因子，可作为生物密封剂，促进胸膜闭合。病例报告：一名76岁男性，前吸烟者，慢性阻塞性肺病和多种合并症，因右侧气胸伴肺萎陷而出现严重急性呼吸困难和持续咳嗽。插入水封肋间胸腔引流管；尽管呼吸窘迫有所改善，但持续的空气泄漏仍在继续。高分辨率计算机断层扫描证实右侧气胸伴肺不张和多发肺气肿大泡。考虑到手术风险高，通过现有胸管，每隔一天给药3单位abo相容新鲜冷冻血浆（FFP）。观察到空气泄漏逐渐减少，到第17天完全停止。在x线片确认肺部完全再扩张后，于第20天取出胸管。在6个月的随访中，患者保持临床稳定，无气胸复发或需要进一步胸膜干预。结论胸膜内FFP胸膜切除术可能是一种安全、可行、经济的方法，可用于治疗老年COPD高危患者手术禁忌时的持续性漏气。完全解决可能需要一个漫长的过程；然而，在这种具有挑战性的临床环境中，无并发症的良好结果强化了精心选择的管理策略的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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