case_images: PMC10939507_01
case_images: a-c Inverted placement of EBVs following Gelfoam insertion in B3a, B4, and B8+9+10, respectively. d-f The bronchoscopic view after EBVs were removed. g-i The CT scan showed BPF on the right side caused by severe necrotizing pneumonia on admission. j-l BPF were closed and empyema absorbed shown in CT scan after the treatment. EBV, endobronchial valve; CT, computed tomography; BPF, bronchopleural fistula.
case_images: res-2024-0103-0003-535478_F01.jpg
case_images: PMC10939507_01_res-2024-0103-0003-535478_F01.jpg
case_images: F1
case_images: Pyramidobacter piscolens which are usually found in the mouth and gastrointestinal tract were detected in the microbial culture of sputum and pleural fluid. Persistent air leak and pus-like pleural fluid suggested the existence of BPF and empyema which were also confirmed by bronchoscope and computed tomography scan (shown in Fig. 1). After Gelfoam placement in each segment, two 4.0 EBV and one 5.0 EBV were inserted into B3a, B4, and B8+9+10, respectively (shown in Fig. 1). On day 24 after the procedure, no air leaks were observed, and computed tomography scan showed that the right lung lobe was fully re-expanded (shown in Fig. 1); both chest tubes were removed. The EBVs were also removed on day 43 (shown in Fig. 1), and the patient was discharged with no respiratory support finally.
case_images: a A cord was threaded through the valve protector by a needle. b EBV was pulled into the compression region of the funnel with the cord. c EBV was completely within the compression region, and the cord was removed. EBV, endobronchial valve.
case_images: res-2024-0103-0003-535478_F02.jpg
case_images: PMC10939507_01_res-2024-0103-0003-535478_F02.jpg
case_images: F2
case_images: For the inverted EBV loading, we used a needle with a cord to thread through the valve protector around the valve, threaded the cord into the compression region of funnel to pull the EBV into the compression region carefully until the EBV was completely within the region, and then removed the cord (shown in Fig. 2).
case_images: The treatment process and outcome of the patient.
case_images: res-2024-0103-0003-535478_F03.jpg
case_images: PMC10939507_01_res-2024-0103-0003-535478_F03.jpg
case_images: F3
case_images: The whole treatment process was shown in Figure 3.