Novel Insights from Clinical Practice Autologous Blood Patch Pleurodesis and Endobronchial Valves for Management of Persistent Air Leaks in Two Cases of Tuberculosis

Introduction: Pulmonary infections, such as tuberculosis, can result in numerous pleural complications including empyemas, pneumothoraces with broncho-pleural fistulas, and persistent air leak (PAL). While definitive surgical interventions are often initially considered, management of these complications can be particularly challenging if a patient has an active infection and is not a surgical candidate. Case Presentation: Autologous blood patch pleurodesis and endobronchial valve placement have both been described in remedying PALs effectively and safely. PALs due to broncho-pleural fistulas in active pulmonary disease are rare, and we present two such cases that were managed with autologous blood patch pleurodesis and endobronchial valves. Conclusion: The two cases presented illustrate the complexities of PAL management and discuss the treatment options that can be applied to individual patients. Established FactsPersistent air leak (PAL) due to broncho-pleural fistulas (BPFs) can be difficult to treat in patients who are not surgical candidates or have failed prior interventions.Autologous blood patch pleurodesis is a safe and effective treatment for PAL most commonly in the postoperative setting.The use of endobronchial valves has been described to ameliorate PAL due to BPFs, though experience remains limited in pleuropulmonary tuberculosis.