CRA26 A MINIMALLY INVASIVE APPROACH TO PERSISTENT AIR LEAK: AUTOLOGOUS BLOOD PATCH PLEURODESIS IN SECONDARY SPONTANEOUS PNEUMOTHORAX

Fion Suet Li Liew¹, Boon Hau Ng¹, Nor Safiqah Sharil², Rose Azzlinda Osman¹, Hsueh Jing Low³, Nik Nuratiqah Nik Abeed¹, Andrea Yu-Lin Ban¹
1. Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
2. Department of Anesthesiology and Critical Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
3. Internal Medical Unit, Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan.

Introduction
Secondary spontaneous pneumothorax (SSP) is a potentially life-threatening condition, especially in elderly patients with underlying lung disease. Persistent air leaks (PAL) complicate management and increase morbidity. While surgical and bronchoscopic interventions are standard treatments, these approaches may pose significant risks in patients with advanced age or comorbidities. Autologous blood patch pleurodesis (ABPP) is an effective, minimally invasive alternative for managing PAL when conventional methods fail.

Case Report
An 82-year-old man presented with acute left-sided chest pain and dyspnea lasting one day. He was a former smoker with a 50-pack-year history. On examination, he was tachycardic (110 beats/min), hypotensive (blood pressure 92/62 mm Hg), and hypoxemic (oxygen saturation 80% on room air). Lung auscultation revealed reduced breath sounds on the right hemithorax with contralateral tracheal deviation. Bedside ultrasound confirmed a right pneumothorax due to the absence of pleural sliding. An immediate 24 Fr chest tube was inserted, followed by a larger 28 Fr chest tube due to worsening subcutaneous emphysema and a partially expanded right lung (figure 1A & 1B).

Computed tomography of the thorax revealed panlobular emphysema without evidence of a bronchopleural fistula. Despite appropriate chest tube placement, the air leak persisted (Cerfolio grade 1) on day five of admission. Given the patient's high surgical risk and the partial lung re-expansion, ABPP was performed. A total of 120 ml of the patient's blood (2 ml/kg) was instilled through the chest tube, which was then elevated for two hours to prevent blood regurgitation. Within 72 hours, the air leak resolved, and complete lung re-expansion was achieved (figure 1C). The chest tube was subsequently removed without recurrence.

Discussion
This case highlights the successful use of ABPP in managing PAL in a high-risk patient with SSP. ABPP is a safe, cost-effective alternative when surgical intervention is contraindicated, providing a practical solution for persistent air leaks in selected patients.