ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Endobronchial Lung Valve Placement for Advanced Emphysema Complicated by Lung Abscess: Case Report and Literature Review
Session Title
TP38 - TP038 INTERESTING AND CHALLENGING CASES IN INTERVENTIONAL PULMONOLOGY
Abstract
A2190 - Endobronchial Lung Valve Placement for Advanced Emphysema Complicated by Lung Abscess: Case Report and Literature Review
Author Block: A. Watts1, A. G. Duarte2, S. P. Nishi3; 1Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, United States, 2Univ of Texas Med Branch, Galveston, TX, United States, 3Univ Of Texas Med Branch, Galveston, TX, United States.
Placement of endoscopic lung valves has emerged as a minimally-invasive treatment for pneumothorax with persistent air leaks and advanced emphysema. Endobronchial valves are unidirectional devices that limit air flow to regions of injured or overinflated lung while allowing airway secretions and gas to be exhaled. In cases of persistent air leak, the reduction in airflow to the lung region diminishes airflow through the fistula and allows the lung defect to heal. In the treatment for advanced emphysema, endobronchial valve placement reduces lung hyperinflation. We present a case of Methicillin-Resistant Staphylococcus aureus (MRSA) bacteremia secondary to lung abscess formation after Zephyr endobronchial valve placement.
A 77-year-old male with a past medical history of GOLD D COPD (FEV1 26% predicted, TLC 121% predicted, residual volume 201% predicted) underwent initial ELVR in April 2019 with 7 Zephyr valves deployed in the right lower lobe. He subsequently underwent valve revision in November 2020 with exchange of 2 Zephyr valves in the right lower lobe. His immediate post-procedure course was complicated by right pneumothorax requiring tube thoracostomy for 5 days with resolution of air leak.
Four weeks later, the patient presented to the emergency department with fevers, cough, halitosis, and weight loss. Computed Tomography (CT) scan on hospital admission demonstrated a 9.2 x 12.0 x 7.0 cm thick-walled fluid collection with air-fluid levels, consistent with abscess formation in the right lower lobe. Percutaneous CT-guided drainage of the abscess was performed. Cultures from both the blood and lung abscess demonstrated methicillin-resistant Staphylococcus aureus. The patient was treated with prolonged antibiotic therapy with plan for repeat bronchoscopic evaluation and potential valve retrieval.
ELVR decreases lung hyperinflation in diseased areas of the lung using endobronchial valves that allow air to exit a targeted lobe during expiration while preventing air from entering the diseased lung during inspiration. ELVR could predispose to post-obstructive infectious processes if pulmonary secretions cannot be expectorated. Data from randomized clinical trials suggests that a minority of patients will develop infectious complications post-ELVR that can generally be managed with standard antibiotic therapy alone and very rarely require valve removal. Most of these include COPD exacerbations (5-64%), pneumonia (0-9%) and less than 8 reported cases of lung abscess. With increasing use of ELVR in advanced COPD, providers must recognize atypical complications of the procedure to effectively counsel patients regarding risks of valve placement.
Author Block: A. Watts1, A. G. Duarte2, S. P. Nishi3; 1Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, United States, 2Univ of Texas Med Branch, Galveston, TX, United States, 3Univ Of Texas Med Branch, Galveston, TX, United States.
Placement of endoscopic lung valves has emerged as a minimally-invasive treatment for pneumothorax with persistent air leaks and advanced emphysema. Endobronchial valves are unidirectional devices that limit air flow to regions of injured or overinflated lung while allowing airway secretions and gas to be exhaled. In cases of persistent air leak, the reduction in airflow to the lung region diminishes airflow through the fistula and allows the lung defect to heal. In the treatment for advanced emphysema, endobronchial valve placement reduces lung hyperinflation. We present a case of Methicillin-Resistant Staphylococcus aureus (MRSA) bacteremia secondary to lung abscess formation after Zephyr endobronchial valve placement.
A 77-year-old male with a past medical history of GOLD D COPD (FEV1 26% predicted, TLC 121% predicted, residual volume 201% predicted) underwent initial ELVR in April 2019 with 7 Zephyr valves deployed in the right lower lobe. He subsequently underwent valve revision in November 2020 with exchange of 2 Zephyr valves in the right lower lobe. His immediate post-procedure course was complicated by right pneumothorax requiring tube thoracostomy for 5 days with resolution of air leak.
Four weeks later, the patient presented to the emergency department with fevers, cough, halitosis, and weight loss. Computed Tomography (CT) scan on hospital admission demonstrated a 9.2 x 12.0 x 7.0 cm thick-walled fluid collection with air-fluid levels, consistent with abscess formation in the right lower lobe. Percutaneous CT-guided drainage of the abscess was performed. Cultures from both the blood and lung abscess demonstrated methicillin-resistant Staphylococcus aureus. The patient was treated with prolonged antibiotic therapy with plan for repeat bronchoscopic evaluation and potential valve retrieval.
ELVR decreases lung hyperinflation in diseased areas of the lung using endobronchial valves that allow air to exit a targeted lobe during expiration while preventing air from entering the diseased lung during inspiration. ELVR could predispose to post-obstructive infectious processes if pulmonary secretions cannot be expectorated. Data from randomized clinical trials suggests that a minority of patients will develop infectious complications post-ELVR that can generally be managed with standard antibiotic therapy alone and very rarely require valve removal. Most of these include COPD exacerbations (5-64%), pneumonia (0-9%) and less than 8 reported cases of lung abscess. With increasing use of ELVR in advanced COPD, providers must recognize atypical complications of the procedure to effectively counsel patients regarding risks of valve placement.
