Local radiotherapy for alveolar air leak

Treatment of a prolonged air leak with radiotherapy: a case report

Pneumothorax is defined as air in the pleural space. Depending on the severity of the pneumothorax, treatment consists of oxygen therapy, simple aspiration, tube thoracostomy, and pleurodesis. Prolonged air leakage is observed in 25% of the patients who have undergone surgical procedures, such as thoracotomy, pleurectomy, and video-assisted thoracoscopy. The patient presented here is the third reported case successfully treated with radiotherapy. Ventilation scintigraphy was used to localise the air leak, and localised radiotherapy was performed at the targeted location. After radiotherapy, the air leak ceased and at the 3-month followup, the pneumothorax had not recurred. Radiotherapy can be a treatment modality for patients with prolonged air leak, who are not candidates for surgery.

Predictors of alveolar air leaks

Persistent air leaks are caused by the failure of the postoperative lung to achieve a configuration that is physiologically amenable to healing. The raw pulmonary surface caused by the dissection of the fissure often is separated from the pleura, and the air leak fails to close. Additionally, higher air flow thorough an alveolar-pleural fistula seems to keep the fistula open. Other factors that interfere with wound healing, such as steroid use, diabetes, or malnutrition, can result in persistence of the leak. A thoracic surgeon can minimize the incidence of air leak through meticulous surgical technique and can identify patients in whom the balance of risks (Table 1) and benefits warrant operative intervention based on an understanding of the underlying pathophysiology.