RESUMO
A 9-year-old previously well girl presented with multiple episodes of large volume haemoptysis and right sided consolidation. She continued to have haemoptysis despite intravenous antibiotics. CT chest suggested a right mainstem endobronchial lesion; this was not seen on bronchoscopy where an extensive blood clot was removed. Distal flexible bronchoscopy could not identify the source of bleeding. CT angiogram revealed a broncho-pulmonary arterial fistula, a rare cause of haemoptysis in children. Endovascular embolisation resulted in short-term symptom resolution; however, haemoptysis recurred months later, leading to re-embolisation. This case highlights a stepwise approach to the workup of large volume haemoptysis.
Assuntos
Fístula Brônquica , Broncoscopia/métodos , Angiografia por Tomografia Computadorizada/métodos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Hemoptise , Artéria Pulmonar , Fístula Vascular , Fístula Brônquica/diagnóstico , Fístula Brônquica/fisiopatologia , Fístula Brônquica/cirurgia , Criança , Diagnóstico Diferencial , Feminino , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Pulmão/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Recidiva , Reoperação , Resultado do Tratamento , Fístula Vascular/diagnóstico , Fístula Vascular/fisiopatologia , Fístula Vascular/cirurgiaAssuntos
Fístula Brônquica , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos , Tuberculose Pulmonar , Assistência ao Convalescente/métodos , Idoso , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/fisiopatologia , Tosse/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Humanos , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnósticoRESUMO
CASE PRESENTATION: A 57-year-old man was admitted for 1 month of accelerating hemoptysis and hematemesis. Two weeks earlier, he first presented with fevers and hemoptysis of 2 weeks' duration and was diagnosed with community-acquired pneumonia treated with 5 days of ceftriaxone and azithromycin. He improved and was discharged, but his hemoptysis recurred 1 day after discharge and progressed over 9 days, leading to the present admission. He endorsed an 5-kg weight loss, daily fevers up to 39.4°C, and night sweats since discharge. His medical history was significant for peptic ulcer disease complicated by a perforated gastric ulcer 30 years ago, type 2 diabetes, and Barrett esophagus with recent normal upper endoscopy. The patient had coarctation of the aorta repaired 35 years ago. The patient takes aspirin, atorvastatin, and pantoprazole. He emigrated from Mexico 10 years before presentation and lives in Texas with his family. He returns to Mexico several times per year, most recently 2 days before admission. He works at a supermarket. He does not smoke, drink, or use illicit drugs. He denied sick contacts, pets, or incarceration.
Assuntos
Antibacterianos/administração & dosagem , Coartação Aórtica/cirurgia , Fístula Brônquica , Hematemese , Hemoptise , Infecções Relacionadas à Prótese , Reoperação/métodos , Fístula Vascular , Aorta Torácica/diagnóstico por imagem , Prótese Vascular/efeitos adversos , Prótese Vascular/microbiologia , Fístula Brônquica/diagnóstico , Fístula Brônquica/etiologia , Fístula Brônquica/fisiopatologia , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Progressão da Doença , Febre/diagnóstico , Febre/etiologia , Hematemese/diagnóstico , Hematemese/etiologia , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/fisiopatologia , Resultado do Tratamento , Fístula Vascular/diagnóstico , Fístula Vascular/etiologia , Fístula Vascular/fisiopatologia , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodosAssuntos
Antituberculosos/administração & dosagem , Fístula Brônquica , Pneumonectomia , Pneumopericárdio , Complicações Pós-Operatórias , Reoperação/métodos , Tuberculose Pulmonar/cirurgia , Brônquios/cirurgia , Fístula Brônquica/diagnóstico , Fístula Brônquica/fisiopatologia , Fístula Brônquica/cirurgia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cavidade Pleural/microbiologia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Pneumopericárdio/diagnóstico , Pneumopericárdio/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Testes de Função Respiratória/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Tuberculose Pulmonar/diagnósticoRESUMO
We report an unusual presentation of pulmonary embolism (PE) where a 58-year-old man first developed symptoms of community-acquired pneumonia. Despite antibiotic therapy, he remained unwell with rising inflammatory markers, general malaise and persistent cough. He developed stony dull percussion and absent breath sounds to his left mid to lower zones. Serial chest x-rays showed progression from lobar consolidation to a large loculated left-sided pleural collection. CT chest showed left-sided lung abscess, empyema and bronchopleural fistulation. Incidentally, the scan revealed acute left-sided PE and its distribution corresponded with the location of the left lung abscess and empyema. The sequence of events likely started with PE leading to infarction, cavitation, abscess formation and bronchopleural fistulation. This patient was managed with a 6-month course of rivaroxaban. After completing 2 weeks of intravenous meropenem, he was converted to 4-week course of oral co-amoxiclav and metronidazole and attained full recovery.
Assuntos
Abscesso/diagnóstico por imagem , Antibacterianos/uso terapêutico , Fístula Brônquica/diagnóstico por imagem , Infarto/diagnóstico por imagem , Doenças Pleurais/diagnóstico por imagem , Pneumonia/tratamento farmacológico , Embolia Pulmonar/diagnóstico por imagem , Radiografia Torácica , Abscesso/tratamento farmacológico , Abscesso/patologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Fístula Brônquica/tratamento farmacológico , Fístula Brônquica/fisiopatologia , Progressão da Doença , Quimioterapia Combinada , Humanos , Infarto/tratamento farmacológico , Infarto/fisiopatologia , Masculino , Meropeném , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Doenças Pleurais/tratamento farmacológico , Doenças Pleurais/fisiopatologia , Pneumonia/diagnóstico por imagem , Pneumonia/fisiopatologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/fisiopatologia , Rivaroxabana/uso terapêutico , Tienamicinas/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Patients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature. CASE PRESENTATION: A 61-year-old Caucasian man presented with a history of unintentional weight loss and dyspnea both at rest and with exertion. He had a significant tobacco and alcohol misuse history. A massive right-sided pleural effusion was found on chest X-ray, which responded partially to chest tube insertion. A computed tomography scan of his thorax confirmed the presence of innumerable lung abscesses as well as a complex pleural effusion. An indeterminate tiny air pocket at the dome of the liver was also noted. A follow-up computed tomography scan of his abdomen revealed a decompressed hepatic abscess extending into the right pleural space and the right lower lobe. A sigmoid-rectal fistula was also revealed with focal colonic thickening, presumed to be the sequelae of remote or chronic diverticulitis. An interventional radiologist inserted a percutaneous drain into the decompressed hepatic abscess and the instillation of contrast revealed immediate filling of the right pleural space, lung parenchyma, and bronchial tree, confirming a hepato-bronchial fistula. After two concurrent chest tube insertions failed to drain the remaining pleural effusion completely, surgical lung decortication was conducted. Markedly thickened pleura were seen and a significant amount of gelatinous inflammatory material was debrided from the lower thoracic cavity. He recovered well and was discharged 10 days post-thoracotomy on oral antibiotics. The percutaneous liver abscess tube was removed 3 weeks post-discharge from hospital after the drain check revealed that the fistula and abscess had entirely resolved. CONCLUSIONS: Refractory right-sided pleural effusion combined with constitutional symptoms should alert clinicians to search for possible hepatic abscess, especially in the context of diverticulitis. The rupture of an untreated hepatic abscess could lead to death from profound sepsis or rarely, as in this case, a hepato-bronchial fistula. Timely investigation and a multidisciplinary treatment approach can lead to improved patient outcomes.
Assuntos
Fístula Biliar/diagnóstico , Fístula Brônquica/diagnóstico , Cateterismo/métodos , Colo Sigmoide/patologia , Doença Diverticular do Colo/diagnóstico , Dispneia/etiologia , Abscesso Hepático/patologia , Derrame Pleural/diagnóstico por imagem , Radiografia Torácica , Toracotomia , Fístula Biliar/fisiopatologia , Fístula Biliar/cirurgia , Fístula Brônquica/fisiopatologia , Fístula Brônquica/cirurgia , Colo Sigmoide/diagnóstico por imagem , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Drenagem , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/cirurgia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: Pulmonary hydatid cysts are recognized to have high rate of rupture compared to those in other affected organs. To identify risk factors associated with endobronchial rupture, we prospectively assessed 32 patients with hydatid cysts. There were 21 males and 11 females, with a mean age of 32 ± 15 years (range 9 to 65 years). METHODS: All patients undergoing thoracotomies for hydatid cysts were included. Demographic data, site, size, and whether cysts were ruptured or intact, were reviewed. Intraoperatively, bronchial fistula diameters were measured. A stepwise multiple logistic regression model was used to analyze the results. RESULTS: Seventeen (53.1%) patients presented with ruptured cysts (group 1) and 15 with intact cysts (group 2). There was a significant difference in mean fistula diameter between groups: 6.16 ± 2 mm in group 1 vs. 0.34 ± 0.19 mm in group 2 (p ≤ 0.0001), which was identified as the only significant risk factor associated with cyst rupture. CONCLUSION: At the fistula site, the intracystic pressure is unopposed, leading to herniation of the endocyst membrane, disruption of its integrity, and rupture. Therefore, we postulate that this scenario in combination with other coexisting factors could be the possible mechanism for cyst rupture in group 1. This concept may also explain the pathogenesis of the high rate of rupture of pulmonary hydatid cysts. Accordingly, we consider these cysts a naturally occurring model for rupture, which should be treated surgically as soon as the diagnosis is made, to avoid complications.
Assuntos
Fístula Brônquica/etiologia , Equinococose Pulmonar/complicações , Adolescente , Adulto , Idoso , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/fisiopatologia , Fístula Brônquica/cirurgia , Broncoscopia , Criança , Equinococose Pulmonar/diagnóstico por imagem , Equinococose Pulmonar/fisiopatologia , Equinococose Pulmonar/cirurgia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pressão , Estudos Prospectivos , Fatores de Risco , Ruptura Espontânea , Arábia Saudita , Toracotomia , Adulto JovemAssuntos
Fístula Biliar , Fístula Brônquica , Carcinoma Hepatocelular , Quimioembolização Terapêutica/métodos , Tosse , Drenagem/métodos , Abscesso Hepático , Cirrose Hepática , Idoso , Fístula Biliar/diagnóstico , Fístula Biliar/etiologia , Fístula Biliar/fisiopatologia , Fístula Biliar/terapia , Fístula Brônquica/diagnóstico , Fístula Brônquica/etiologia , Fístula Brônquica/fisiopatologia , Fístula Brônquica/terapia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Tosse/diagnóstico , Tosse/etiologia , Tosse/fisiopatologia , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/etiologia , Abscesso Hepático/cirurgia , Cirrose Hepática/complicações , Cirrose Hepática/virologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Radiografia , Resultado do TratamentoRESUMO
Roughly 10% of lung transplant recipients experience airway complications. Although the incidence has decreased dramatically since the first lung transplants were performed in the 1960s, airway complications have continued to adversely affect outcomes. Bronchoscopic interventions such as balloon dilation, airway stenting, and endobronchial electrocautery play an important role in ameliorating the morbidity and mortality associated with these complications. This review describes the array of bronchoscopic interventions used to treat airway complications after lung transplant and how these techniques can be used in nontransplant settings as well.
Assuntos
Obstrução das Vias Respiratórias/terapia , Fístula Brônquica/terapia , Broncomalácia/terapia , Broncoscopia , Granuloma do Sistema Respiratório/terapia , Transplante de Pulmão/efeitos adversos , Pulmão/cirurgia , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/mortalidade , Obstrução das Vias Respiratórias/fisiopatologia , Coagulação com Plasma de Argônio , Fístula Brônquica/etiologia , Fístula Brônquica/mortalidade , Fístula Brônquica/fisiopatologia , Broncomalácia/etiologia , Broncomalácia/mortalidade , Broncomalácia/fisiopatologia , Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/mortalidade , Dilatação , Granuloma do Sistema Respiratório/etiologia , Granuloma do Sistema Respiratório/mortalidade , Granuloma do Sistema Respiratório/fisiopatologia , Humanos , Pulmão/fisiopatologia , Transplante de Pulmão/métodos , Transplante de Pulmão/mortalidade , Fatores de Risco , Stents , Deiscência da Ferida Operatória , Resultado do TratamentoRESUMO
PURPOSE: To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS: Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF. RESULTS: Significant reduction in BPF output and PaCO2 was related after insertion of a water-sealed thoracic drain, p< 0.05. CONCLUSION: Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO2 clearance without any drop in cardiac output or significant changes in mean arterial pressure.
Assuntos
Fístula Brônquica/fisiopatologia , Modelos Animais de Doenças , Hemodinâmica/fisiologia , Doenças Pleurais/fisiopatologia , Ventilação Pulmonar/fisiologia , Animais , Gasometria , Fístula Brônquica/sangue , Fístula Brônquica/terapia , Débito Cardíaco/fisiologia , Drenagem/métodos , Doenças Pleurais/sangue , Doenças Pleurais/terapia , Valores de Referência , Reprodutibilidade dos Testes , Respiração Artificial/métodos , Testes de Função Respiratória , Suínos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS : Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF. RESULTS: Significant reduction in BPF output and PaCO2 was related after insertion of a water-sealed thoracic drain, p< 0.05. CONCLUSION: Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO2 clearance without any drop in cardiac output or significant changes in mean arterial pressure. .
Assuntos
Animais , Fístula Brônquica/fisiopatologia , Modelos Animais de Doenças , Hemodinâmica/fisiologia , Doenças Pleurais/fisiopatologia , Ventilação Pulmonar/fisiologia , Gasometria , Fístula Brônquica/sangue , Fístula Brônquica/terapia , Débito Cardíaco/fisiologia , Drenagem/métodos , Doenças Pleurais/sangue , Doenças Pleurais/terapia , Valores de Referência , Reprodutibilidade dos Testes , Testes de Função Respiratória , Respiração Artificial/métodos , Suínos , Fatores de Tempo , Resultado do TratamentoRESUMO
Endovascular and open surgical repair have been used in patients with descending thoracic aortic dissection; however, the appropriate treatment is debated. We describe the case of a 60-year-old woman who had a symptomatic, chronic, residual, descending thoracic aortic dissection that was complicated by an aortobronchial fistula. She underwent emergent thoracic endovascular stent-grafting but remained symptomatic. Computed tomographic angiograms showed a contained rupture into the lower lobe of the left lung. The patient underwent definitive surgery to remove the stents, reconstruct the aorta, and resect the nonviable lung tissue. The remainder of her postoperative course was uneventful, and she was discharged from the hospital 13 days after the 2nd operation. Results of genetic testing confirmed an earlier presumptive diagnosis of Marfan syndrome. In an emergency, the best initial option for patients with a complicated descending thoracic aortic dissection might be thoracic endovascular aortic repair, which could serve as a bridge to definitive open repair.
Assuntos
Implante de Prótese Vascular , Fístula Brônquica , Remoção de Dispositivo/métodos , Pneumonectomia/métodos , Complicações Pós-Operatórias , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/etiologia , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Angiografia/métodos , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Fístula Brônquica/diagnóstico , Fístula Brônquica/etiologia , Fístula Brônquica/fisiopatologia , Fístula Brônquica/cirurgia , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Lesão Pulmonar , Síndrome de Marfan/complicações , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Stents/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Positive pressure ventilation in patients with a bronchopleural fistula (BPF) is associated with variable, unpredictable gas leaks that can impair gas exchange. The optimum settings for high-frequency jet ventilation in this scenario are unclear. We investigated flow dynamics with BPFs of 2 and 10 mm, at various positions and with different jet ventilator settings in a bench-top model. METHODS: A 2 or 10 mm length fistula was created at proximal, middle, or distal sites in standard artificial ventilator 'test' lungs and cadaveric porcine lungs. The effects of alterations in frequency, applied pressure, and on entrained, expired, and leak volumes were determined using gauge and differential pressure sensors. RESULTS: Entrained, delivered, and leak volumes were affected markedly by ventilator settings, particularly frequency: leaks were much greater at frequencies <100 min(-1). The leak/expired volume ratio varied between 0% and 92%. Leak and entrained volumes increased progressively with more proximally situated fistulae, whereas the measured expired volume decreased. Leak volumes with a 2 mm fistula were approximately half that of a 10 mm fistula across all ventilator frequencies. All volumes increased with increased driving pressure. The optimum injection time varied depending on BPF position and the accepted compromise between leak and expired volumes. Entrained volume contributed up to 50% of the total tidal volume. CONCLUSIONS: These data suggest that gas leak will be minimized and ventilator volumes maintained during jet ventilation using frequencies >200 min(-1) and lower driving pressures, but confirmatory clinical studies are required. Values displayed by the jet ventilator are unreliable.
Assuntos
Ventilação em Jatos de Alta Frequência/métodos , Modelos Biológicos , Doenças Pleurais/fisiopatologia , Ventilação Pulmonar/fisiologia , Fístula do Sistema Respiratório/fisiopatologia , Animais , Fístula Brônquica/fisiopatologia , Suínos , Volume de Ventilação PulmonarRESUMO
Se describen dos nuevos signos endoscópicos que podrán resultar de utilidad para mejorar el rendimiento diagnóstico de la broncoscopia. Un ensayo semiológico sobre circunstancias anatómicas y funcionales particulares, que declaran la existencia de una afección cercana, pero fuera del alcance de observación del broncoscopista. Estos dos signos son el signo de la burbuja y el signo del agujero negro. El signo de la burbuja se observa cuando no hay flujo del aire en un subsegmento bronquial que conduce a una masa pulmonar periférica. Esto se manifiesta por la ausencia de burbujas móviles cuando se inyecta una solución salina en el subsegmento bronquial. El signo del agujero negro consiste en una penumbra circular observada en el extremo de un bronquio que se comunica con una cavidad. Se describen las formas de presentación e interpretación de estos signos y también se ofrece una explicación acerca de su fisiopatología.
The paper describes two new endoscopic signs which can be useful in the use of diagnostic bronchoscopy. This is an essay on particular anatomic and functional circumstances suggesting the presence of a pathology which cannot be seen by the bronchoscopist. These two signs are the Bubble Sign and the Black Hole Sign. The Bubble Sign is observed when the airflow is absent in a subsegmental bronchus leading to a peripheral pulmonary mass. This can be shown by the lack of mobile bubbles when a subsegmental bronchus is flooded with saline solution. The Black Hole Sign consists in the circular penumbra observed at the end of a bronchus which communicates with a cavity. The paper describes the presentation and interpretation of these signs and offers an explanation about their physiopathology.
Assuntos
Neoplasias Brônquicas , Fístula Brônquica/fisiopatologia , Pulmão/patologia , BroncoscopiaRESUMO
Enternal nutritional support, a frequently applied technique for providing nutrition and energy, played a pivotal role in the treatment of high risk patients. However, severe complications induced by malposition of nasogastric tube caused great danger and even death to the patients. In this case report, we present a patient with severe acute respiratory distress syndrome (ARDS) induced by bronchopleural fistula (BPF) due to malposition of nasogastric tube. Repeated lung lavage combined with extracorporeal membrane oxygenation (ECMO) was performed after transferring to the ICU of our hospital. Finally, the patient recovered and discharged 7 days after admission.
Assuntos
Fístula Brônquica/etiologia , Lavagem Broncoalveolar , Oxigenação por Membrana Extracorpórea , Intubação Gastrointestinal/efeitos adversos , Erros Médicos/efeitos adversos , Derrame Pleural/etiologia , Síndrome do Desconforto Respiratório/terapia , Idoso , Brônquios/lesões , Fístula Brônquica/fisiopatologia , Nutrição Enteral , Alimentos Formulados/efeitos adversos , Humanos , Masculino , Paracentese , Pleura/lesões , Derrame Pleural/fisiopatologia , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/fisiopatologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The treatment results of the 286 patients with pleural empyem after thoracic injuries (n=107) and closed trauma of the pleural cavity (n=179) were retrospectively analyzed. The frequency of pleural empyem was 1.39% by injuries and 1.34% by the closed thoracic trauma. 15 (14%) patients of the first group developed the bronchopleural fistula, whereas the complication was observed in 32 (17.9%) patients of the second group. The adequate pleural drainage with intrapleural enzyme therapy in acute inflammation period allowed recovery in 78% and 71.9% of patients, respectively. Early videothoracoscopic sanation of the pleural cavity shortened the recovery time in more then 1.5 times. The chronization of the empyem was more often observed after the closed thoracic trauma - 14.5% rather than 6.5% after the open thoracic injury. The lethality rate by pleural empyem was 14% after the open injuries and 15.6% after the closed trauma.
Assuntos
Fístula Brônquica/cirurgia , Drenagem/métodos , Empiema Pleural , Pleura , Traumatismos Torácicos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Fístula Brônquica/etiologia , Fístula Brônquica/fisiopatologia , Empiema Pleural/etiologia , Empiema Pleural/fisiopatologia , Empiema Pleural/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Hidrolases/uso terapêutico , Pleura/lesões , Pleura/cirurgia , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/fisiopatologia , Traumatismos Torácicos/cirurgia , Resultado do TratamentoRESUMO
A 78-year-old woman was admitted to our hospital with intermittent hemoptysis. She had undergone descending aortic replacement through a left thoracotomy 7 years previously. Enhanced computed tomography revealed a pseudoaneurysm at the proximal suture line in the descending aorta and an ascending aortic aneurysm. Bronchoscope revealed bleeding from the left lower bronchus. Ascending and total aortic arch replacement and simultaneous open stent-graft placement into the descending aorta were performed through a median sternotomy. Selective antegrade cerebral perfusion and moderate hypothermia were used during these procedures. The postoperative course was favorable. Open stent-graft placement is a good alternative for treating aortobronchial fistula caused by suture line pseudoaneurysm in the descending aorta.