ArticleRespiratory medicine case reports2026
Fresh frozen plasma pleurodesis for bronchopleural fistula following secondary spontaneous pneumothorax due to ruptured emphysematous bullae in a high-risk elderly COPD patient.
Article in Respiratory medicine case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Persistent air leak (PAL) secondary to bronchopleural fistula (BPF) is a serious complication of secondary spontaneous pneumothorax (SSP) resulting from ruptured emphysematous bullae in patients with chronic obstructive pulmonary disease (COPD). Management is particularly challenging in elderly high-risk individuals who are unsuitable for surgical intervention. Fresh frozen plasma (FFP), containing fibrinogen and coagulation factors, may act as a biological sealant and facilitate pleural closure. Case report: A 76-year-old man, a former smoker with COPD and multiple comorbidities presented with severe acute dyspnea and persistent cough due to right-sided pneumothorax with lung collapse. A water-sealed intercostal chest drain was inserted; although respiratory distress improved, a persistent air leak continued. High-resolution computed tomography confirmed right-sided pneumothorax with associated lung atelectasis and multiple emphysematous bullae. Given the high surgical risk, a total of three units of ABO-compatible fresh frozen plasma (FFP) were administered intrapleurally through the existing chest tube on alternate days. A gradual reduction in air leak was observed, with complete cessation by day 17. The chest tube was removed on day 20 following radiographic confirmation of full lung re-expansion. At 6-month follow-up, the patient remained clinically stable without recurrence of pneumothorax or the need for further pleural intervention. Conclusion: Intrapleural FFP pleurodesis may represent a safe, feasible, and cost-effective alternative for managing persistent air leak in high-risk elderly COPD patients when surgical options are contraindicated. Complete resolution may require a prolonged course; however, the favorable outcome without complications reinforces the value of a carefully selected management strategy in this challenging clinical context.
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