CRA7 PERSISTENT AIR LEAK IN DISTRICT SETTING: A CASE SERIES

Zulkifli.S¹
Hospital Pakar Sultanah Fatimah, Muar

Introduction
Persistent air leak (PAL), defined as an ongoing leak beyond five days post chest tube insertion, poses a significant challenge in district hospitals with limited access to thoracic surgery. We present a case series illustrating resource-conscious approaches to PAL management in such a setting.

Case Series
Case 1: A 70-year-old man with emphysematous COPD had a Cerfolio grade 1 air leak. Two rounds of autologous blood pleurodesis (ABBP) failed to resolve the leak. He was discharged with a Sinapi® valve, achieving full lung expansion by follow-up.

Case 2: A 67-year-old ex-smoker with COPD and prior TB had a grade 2 air leak. A single ABBP session (1 mL/kg) stopped the leak within 24 hours.

Case 3: A 63-year-old woman with fibrotic lung and bronchiectasis presented with recurrent pneumothorax and probable trapped lung. PAL resolved with 48 hours of low-pressure suction at –10 cmH₂O.

Case 4: A 69-year-old with bronchiectasis and cirrhosis had a persistent leak despite reinsertion of chest tubes. He was managed with a Sinapi® device, which later dislodged, but spontaneous resolution followed.

Case 5: A 64-year-old woman with newly diagnosed metastatic lung adenocarcinoma developed PAL after thoracentesis. No bronchopleural fistula was seen on CT. PAL resolved after accidental tube dislodgement, likely due to trapped lung physiology.

Conclusion
PAL can be successfully managed in district hospitals using non-surgical methods such as ABBP, low-pressure suction, and ambulatory one-way valves. These cases highlight the importance of tailored, conservative approaches when thoracic surgical options are limited.