Tuberc Respir Dis.  2012 May;72(5):441-447.

Bronchoscopic Ethanolamine Injection Therapy in Patients with Persistent Air Leak from Chest Tube Drainage

• Lim AL
• Kim CH
• Hwang YI
• Lee CY
• Choi JH
• Shin T
• Park YB
• Jang SH
• Park SM
• Kim DG
• Lee MG
• Hyun IG
• Jung KS
• Shin HS

Abstract

BACKGROUND
Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD.
METHODS
Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope.
RESULTS
A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median).
CONCLUSION
Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

Keyword

Bronchoscopy; Chest Tubes; Ethanolamine; Pneumothorax

MeSH Terms

Blister
Bronchi
Bronchoscopy
Chest Pain
Chest Tubes
Drainage
Empyema
Ethanolamine
Fever
Fistula
Humans
Length of Stay
Lung
Needles
Oleic Acid
Oleic Acids
Pleurodesis
Pneumothorax
Pulmonary Disease, Chronic Obstructive
Thoracic Surgery
Thoracoscopy
Thoracotomy
Thorax
Ethanolamine
Oleic Acid
Oleic Acids

Figure

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  Figure 1 Case 1. A 75-year-old male patient who had past history of tuberculosis. Spontaneous pneumothorax, recurrent (A), 2 and 3 days after ethanolamine injection therapy (B, C).

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  Figure 2 Case 9. A 56-year-old male patient who had empyema due to broncho-pleural fistula. Hydropneumothorax (A), 10 and 13 days after ethanolamine injection therapy (B, C).

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  Figure 3 Case 8. A 27-year-old male patient who had spontaneous pneumothorax, first episode. High resolution computed tomography showed multiple bullae and blebs in left apex (not shown). Two days after wedge resection with bullae and blebs plication (A), 1, 2, and 5 days after ethanolamine injection therapy (B~D).

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