Bronchoscopic Localization of a Post-Surgical Persistent Air Leak Facilitating Successful Treatment With a Hybrid Imaging-Guided Percutaneous Sealing of Fistula and Autologous Blood Patch Technique.

Post-surgical persistent air leak (PAL) poses significant management challenges in patients with high surgical risk and complex anatomy. A 58-year-old female with advanced thymoma underwent extensive thoracic resection and developed PAL refractory to conservative management with pleural drain insertion. Chest Computed Tomography (CT) suggested a possible broncho-pleural fistula at the left lower lobe superior segment. Sequential bronchoscopic balloon occlusion under general anaesthesia localized the fistula to the LB6 lateral subsegment with the aid of a digital chest drain system. This was confirmed by methylene blue instillation via bronchoscopy and observation of colour change in the pleural drain fluid. Interventional radiology (IR) subsequently performed CT-fluoroscopy guided percutaneous sealing of fistula using Histoacryl-lipiodol mixture, followed by autologous blood and thrombin instillation via the pleural drain, resulting in obliteration of fistula and complete resolution of PAL. We highlight a unique case of multi-disciplinary collaboration between Pulmonology and IR to successfully treat PAL via a combination of minimally invasive techniques.