A new simple method to detect an air-leaking lung field in pneumothorax by a flexible bronchofiberscope
Tohoku journal of experimental medicine
A new simple method was designed to detect an air-leaking lung field in refractory pneumothorax. A constant volume of 100% helium gas was introduced into each lobe bronchus of two patients with pneumothorax via a flexible bronchofiberscope. In both patients, only when helium gas was introduced into the communicating bronchus with a ruptured emphysematous bullae, a high concentration of helium was detected in the intrathoracic gas. Thoracotomy has been used for patients with pneumothorax in
... neumothorax in which an air-leakage has persistently as well as recurrently continued, but this therapeutical approach has been frequently limited by a patient-age and an underlying disease. An exact detecting of the site of air leakage makes much expectant of an effectiveness of the outlet-closing treatment under a thoracoscope and finally leads to a new transbronchial treatment of pneumothorax. pneumothorax; flexible bronchofiberscope; transbronchial treatment Pneumothorax occurs from a wide variety of causes (Bernhard et al. 1962) . When the collapsed lung does not re-expand by removal of the air in the pleural space, either by thoracentesis or by an intercostal draining catheter and also for a case of repeated episodes of pneumothorax, other managements including open thoracotomy are frequently required. However, a high risk for these managements has been reported in elderly patients with severe underlying pulmonary disease. Therefore, a new therapeutical approach has been expected for these patients. From this view-point, it seems as the first step of a new approach to be important that an airleaking lung field or leaking bronchus are correctly determined. Two patients with pneumothorax were studied. The first patient was a 26-year-old man who had multiple bullae at apex of the lung and the second patient was a 22-year-old man who had a giant bulla at the upper lobe. Both patients have continued to show a persistent air leakage through intercostal tube drainage under a conservative treatment. They were premedicated with 0.4 mg of atropine sulfate and 15 mg of pentazocine intramuscularly and an intercostal tube drainage was carried out at supine position. Under surface anesthesia by 4% xylocaine solution, a flexible bronchofiberscope was inserted into each orifice of lobe bronchus of the collapsed lung and then 50 ml of 100% helium gas was introduced into an orifice of each lobe bronchus through the bronchoscope channel. Immediately after this procedure, 50 ml of intrathoracic gas was obtained through the intercostal tube (Fig. 1) . Helium concentration in the intrathoracic gas was measured by the helium analyzer.