An 8-year-old female with a spontaneous tension pneumothorax leading to cardiac arrest complicated by recurrent bronchopleural fistulas requiring endobronchial valves: a case report.

INTRODUCTION: Persistent air leaks, such as bronchopleural fistulas, cause significant health challenges and diagnostic conundrums in both adult and pediatric patients, often delaying recovery and increasing the risk of severe complications. Traditional treatments include prolonged chest tube placement, ventilator manipulation, medical pleurodesis, extracorporeal membrane oxygenation, or surgery, including lobectomy. While used in adult patients, endobronchial valve placement is an emerging, minimally invasive option for treating persistent air leaks in children who have failed other interventions and are not surgical candidates. CASE PRESENTATION: This unique case describes an 8-year-old Hispanic female with chronic respiratory failure secondary to tracheobronchomalacia and pulmonary hypoplasia, requiring tracheostomy and lifelong ventilator dependence. She was admitted to the pediatric intensive care unit following cardiac arrest secondary to a tension pneumothorax and subsequently developed recurrent bronchopleural fistulas with multiple pneumothoraces requiring chest tube placement. As part of a nonsurgical management approach, multiple endobronchial valves were placed to address persistent air leaks. CONCLUSION: Bronchopleural fistulas are abnormal connections between the bronchial tree and the pleural space, causing persistent air leaks that can complicate lung recovery, especially after lung surgeries, infections, or trauma. Treatment options are varied, and no standardized guidelines exist. This case represents the first reported use of endobronchial valves to treat persistent bronchopleural fistulas in a pediatric patient with chronic lung disease, tracheostomy, and lifelong ventilator dependence, which likely contributed to the recurrence of the bronchopleural fistulas. This case highlights the potential use of endobronchial valves as a minimally invasive alternative to surgery for pediatric patients with persistent air leaks, adding to the current growing literature. It also highlights the challenges faced in this specific pediatric patient population.