New pneumothorax complicating successful treatment of persistent air leak by endobronchial valves

Endobronchial one-way valves (EBV) have been proposed as a treatment option for persistent air leak (PAL) complicating spontaneous pneumothorax when surgical intervention is considered not feasible. Published case series showed this form of treatment to be generally safe. We report two such cases in which both achieved immediate cessation of air leak and post-procedural chest radiograph showed significant collapse of the treated lobe, but developed sudden onset of shortness of breath within 24 h after EBV insertion. Chest radiograph showed continued collapse of the treated lobes with enlarged ipsilateral pneumothorax in one patient and new contralateral pneumothorax in the other. Pulmonologists and thoracic surgeons inserting EBV for treatment of PAL should be aware of this possible and important complication.