ABSTRACT
The etiology of hemoptysis is diverse and complex, with aorta aneurysm being identified as a rare cause of cryptogenic hemoptysis. Here, we reported a 56-year-old male patient who experienced hemoptysis due to a thoracic aorta aneurysm that persisted despite stent implantation. Further investigation revealed the presence of a lateral thoracic artery-pulmonary artery fistula and an aortobronchial fistula, diagnosed by angiography and multidisciplinary consultation. Therefore, patients with recurrent hemoptysis after aortic surgery should be monitored for the possibility of an aortobronchial fistula.
Subject(s)
Aortic Aneurysm, Thoracic , Hemoptysis , Stents , Humans , Male , Hemoptysis/etiology , Hemoptysis/diagnosis , Middle Aged , Stents/adverse effects , Aortic Aneurysm, Thoracic/surgery , Pulmonary Artery , Recurrence , Bronchial Fistula/etiology , Blood Vessel Prosthesis ImplantationABSTRACT
A 67-year-old male was admitted to our hospital for the treatment of pyothorax due to bronchopleural fistula at right main bronchus after pneumonectomy for lung cancer( squamous cell carcinoma, pathological stageâ ¢B). After tube drainage and fenestration, we performed operation to close large diameter fistula, that was almost fully opened stump of the right main bronchus. Omental flap was sutured roughly to the fistula with four stiches and inserted into the bronchus lumen, and covered with latissimus dorsi muscle flap to fix omental pedicle flap and additionally performed thoracoplasty to close the residual space of the pleural cavity. Fistula at the stump became airtight after operation and pyothorax was cured, so our method was thought to be available to close large diameter bronchopleural fistula with omental pedicle flap.
Subject(s)
Bronchial Fistula , Pleural Diseases , Pneumonectomy , Surgical Flaps , Humans , Male , Aged , Pneumonectomy/methods , Bronchial Fistula/surgery , Bronchial Fistula/etiology , Pleural Diseases/surgery , Pleural Diseases/etiology , Lung Neoplasms/surgery , Omentum/transplantation , Omentum/surgery , Postoperative Complications/surgery , Bronchi/surgery , Carcinoma, Squamous Cell/surgeryABSTRACT
BACKGROUND: Lung cancer is the second most diagnosed cancer and the leading cause of cancer deaths worldwide. Surgical lung resection is the best treatment modality in the early stages of lung cancer as well as in some locally advanced cases. Postoperative air leak is one of the most common complications after pulmonary resection with incidence ranging between 20 and 33%. The majority of air leaks seal, within 5 days after surgery, on their own by conservative management. However, at least 5% of patients still have prolonged air coming out from the residual lung at discharge. This report describes the management of a thin lady with right lung cancer who underwent a right lower lobectomy and then suffered from a delayed air leak 7 weeks after surgery and required extensive thoracic and general surgery collaboration. CASE PRESENTATION: A 72-year-old heavy smoker female patient diagnosed with stage I lung cancer underwent right robotic-assisted thoracoscopic surgery converted to thoracotomy because of a fused fissure, right lower lobectomy, and mediastinal lymphadenectomy presented with delayed air leak 49 days after surgery. VATS decortication and mechanical pleurodesis were done 2 weeks after unsuccessful conservative treatment. Still, the lung failed to expand four weeks later so the patient was sent to surgery; she is underweight (BMI of 18) with not many options for a big flap to fill the chest cavity empty space. Accordingly; the decision was to use multiple pedicle flaps; omentum, intercostal muscle, and serratus anterior muscle to cover the bronchopleural fistulas and fill the pleural space in addition to mechanical and chemical pleurodesis. Full expansion of the lung was obtained. The patient was discharged on Post-Operative day 5 without remnant pneumothorax. CONCLUSIONS: Air leaks After lobectomy usually presents directly postoperatively; various management options are available ranging from conservative and minimally invasive to major operative treatment. We presented what we believe was unusual delayed bronchopleural fistula post-lobectomy in a thin lady which demonstrates clearly how a delayed air leak was detected and how collaborative efforts were crucial for delivering high-quality, safe, and patient-centered care till treated and complete recovery.
Subject(s)
Bronchial Fistula , Lung Neoplasms , Pleural Diseases , Pneumonectomy , Postoperative Complications , Humans , Female , Aged , Pneumonectomy/adverse effects , Lung Neoplasms/surgery , Bronchial Fistula/etiology , Bronchial Fistula/surgery , Pleural Diseases/etiology , Pleural Diseases/surgery , Postoperative Complications/surgery , Thoracic Surgery, Video-Assisted/methodsABSTRACT
BACKGROUND: Bronchopleural fistula (BPF) is a rare but fatal complication after pneumonectomy. When a BPF occurs late (weeks to years postoperatively), direct resealing of the bronchial stump through the primary thoracic approach is challenging due to the risks of fibrothorax and injury to the pulmonary artery stump, and the surgical outcome is generally poor. Here, we report a case of late left BPF following left pneumonectomy successfully treated using a right thoracic approach assisted by extracorporeal membrane oxygenation (ECMO). CASE PRESENTATION: We report the case of a 57-year-old male patient who underwent left lower and left upper lobectomy, respectively, for heterochronic double primary lung cancer. A left BPF was diagnosed at the 22nd month postoperatively, and conservative treatment was ineffective. Finally, the left BPF was cured by minimally invasive BPF closure surgery via the right thoracic approach with the support of veno-venous extracorporeal membrane oxygenation (VV-ECMO). CONCLUSIONS: Advanced BPF following left pneumonectomy can be achieved with an individualized treatment plan, and the right thoracic approach assisted by ECMO is a relatively simple and effective method, which could be considered as an additional treatment option for similar patients.
Subject(s)
Bronchial Fistula , Extracorporeal Membrane Oxygenation , Lung Neoplasms , Pleural Diseases , Pneumonectomy , Humans , Male , Pneumonectomy/adverse effects , Extracorporeal Membrane Oxygenation/methods , Middle Aged , Bronchial Fistula/etiology , Bronchial Fistula/surgery , Pleural Diseases/etiology , Pleural Diseases/surgery , Lung Neoplasms/surgery , Postoperative Complications/surgery , Postoperative Complications/therapy , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: A bronchopleural fistula (BPF) occurs when an abnormal connection forms between the bronchial tubes and pleural cavity, often due to surgery, infection, trauma, radiation, or chemotherapy. The outcomes of both surgical and bronchoscopic treatments frequently prove to be unsatisfactory. CASE PRESENTATION: Here, we report a case of successful bronchoscopic free fat pad transplantation combined with platelet-rich plasma, effectively addressing a post-lobectomy BPF. Contrast-enhanced chest tomography revealed pleural thickening with heterogeneous consolidations over the right upper and middle lobes, indicative of destructive lung damage and bronchiectasis. The patient underwent thoracoscopic bilobectomy of the lungs. During surgery, severe adhesions and calcification of the chest wall and lung parenchyma were observed. The entire hilar structure was calcified, presenting challenges for dissection, despite the assistance of energy devices. Bronchoscopic intervention was required, during which two abdominal subcutaneous fat pads were retrieved. CONCLUSION: This innovative approach offers promise in the management of BPF and signals potential advancements in enhancing treatment efficacy and patient recovery.
Subject(s)
Bronchial Fistula , Bronchoscopy , Platelet-Rich Plasma , Pleural Diseases , Humans , Bronchial Fistula/surgery , Pleural Diseases/surgery , Bronchoscopy/methods , Male , Adipose Tissue/transplantation , Middle Aged , Pneumonectomy/methodsABSTRACT
INTRODUCTION: Bronchobiliary fistulas are rare and difficult to treat. Peacock first reported this entity in 1850 while treating a patient with hepatic encopresis. CASE PRESENTATION: A 67-year-old Chinese male patient presented to the outpatient clinic with a complaint of coughing up phlegm with chest tightness for 4 days with symptoms of intermittent bilirubin sputum with a sputum volume of about 500 ml per day but no symptoms of abdominal pain or jaundice and no yellow urine or steatorrhea. The examination revealed cyanosis of the lips and mouth, barrel chest, low breath sounds on the right side, and a large number of wet rales heard in both lungs. The imaging investigations were suggestive of bronchobiliary fistula. Therefore, the patient was operated on and discharged with no perioperative complications. CONCLUSION: Bronchobiliary fistula should be considered diagnostically in patients with known liver disease who also experience trauma or medical treatment and cough up bile-colored sputum, regardless of the presence of concurrent infections, and in conjunction with radiological expertise to identify it. Here, we report a case of bronchobiliary fistula and a brief review of the literature on it.
Subject(s)
Biliary Fistula , Bronchial Fistula , Liver , Humans , Male , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/etiology , Bronchial Fistula/diagnosis , Biliary Fistula/diagnosis , Biliary Fistula/surgery , Aged , Liver/diagnostic imaging , Liver/injuries , Rupture , Tomography, X-Ray ComputedABSTRACT
Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver's unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.
Subject(s)
Bronchial Fistula , Carcinoma, Hepatocellular , Liver Neoplasms , Humans , Male , Carcinoma, Hepatocellular/complications , Middle Aged , Liver Neoplasms/complications , Bronchial Fistula/etiology , Fistula/etiology , Fistula/complications , Heart Diseases/etiology , Heart Diseases/complicationsABSTRACT
BACKGROUND: The management of intractable secondary pneumothorax poses a considerable challenge as it is often not indicated for surgery owing to the presence of underlying disease and poor general condition. While endobronchial occlusion has been employed as a non-surgical treatment for intractable secondary pneumothorax, its effectiveness is limited by the difficulty of locating the bronchus leading to the fistula using conventional techniques. This report details a case treated with endobronchial occlusion where the combined use of transbronchoscopic oxygen insufflation and a digital chest drainage system enabled location of the bronchus responsible for a prolonged air leak, leading to the successful treatment of intractable secondary pneumothorax. CASE PRESENTATION: An 83-year-old male, previously diagnosed with chronic hypersensitivity pneumonitis and treated with long-term oxygen therapy and oral corticosteroid, was admitted due to a pneumothorax emergency. Owing to a prolonged air leak after thoracic drainage, the patient was deemed at risk of developing an intractable secondary pneumothorax. Due to his poor respiratory condition, endobronchial occlusion with silicone spigots was performed instead of surgery. The location of the bronchus leading to the fistula was unclear on CT imaging. When the bronchoscope was wedged into each subsegmental bronchus and low-flow oxygen was insufflated, a digital chest drainage system detected a significant increase of the air leak only in B5a and B5b, thus identifying the specific location of the bronchus leading to the fistula. With the occlusion of those bronchi using silicone spigots, the air leakage decreased from 200 mL/min to 20 mL/min, and the addition of an autologous blood patch enabled successful removal of the drainage tube. CONCLUSION: The combination of transbronchoscopic oxygen insufflation with a digital chest drainage system can enhance the therapeutic efficacy of endobronchial occlusion by addressing the problems encountered in conventional techniques, where the ability to identify the leaking bronchus is dependent on factors such as the amount of escaping air and the location of the fistula.
Subject(s)
Bronchoscopy , Drainage , Insufflation , Pneumothorax , Humans , Pneumothorax/therapy , Pneumothorax/surgery , Male , Aged, 80 and over , Drainage/methods , Bronchoscopy/methods , Insufflation/methods , Oxygen/administration & dosage , Bronchial Fistula/surgery , Bronchial Fistula/therapy , Tomography, X-Ray Computed , Chest Tubes , BronchiSubject(s)
Bronchial Fistula , Pleural Diseases , Subcutaneous Emphysema , Humans , Bronchial Fistula/etiology , Bronchial Fistula/diagnostic imaging , Invasive Pulmonary Aspergillosis/complications , Invasive Pulmonary Aspergillosis/diagnostic imaging , Pleura/pathology , Pleural Diseases/complications , Pleural Diseases/diagnostic imaging , Respiratory Tract Fistula/etiology , Respiratory Tract Fistula/complications , Respiratory Tract Fistula/diagnostic imaging , Subcutaneous Emphysema/etiology , Subcutaneous Emphysema/diagnostic imaging , Tomography, X-Ray Computed , Female , AdultABSTRACT
Broncho-esophageal fistula (BEF) is a severe yet relatively rare connection between the bronchus and esophagus usually caused by esophageal and pulmonary malignancies. We present a case report of a 49-year-old man diagnosed with terminal lung carcinoma who developed a BEF. The thoracic computed tomography scan detected a mass in the left bronchi that partially covers and disrupts the bronchial contour in certain regions and extends to the esophageal wall. After thoroughly evaluating alternative treatment approaches, we opt for the stenting procedure due to the advanced stage of the tumor and the significantly diminished quality of life. The treatment involves the use of a partially covered metal stent that is known to exhibit lower potential to migrate. The treatment is highly successful, resulting in a significant enhancement of the patient's quality of life, a lengthening in his survival, and the ability to pursue additional palliative treatment options. In contrast to the typical prosthesis implantation, our procedure uses a direct endoscopic visualization for the proximal deployment of a partially covered stent, offering a cost-effective and radiation-free alternative that can be particularly beneficial for BEF patients in facilities without radiology services.
Subject(s)
Bronchial Fistula , Esophageal Fistula , Stents , Humans , Male , Middle Aged , Esophageal Fistula/surgery , Esophageal Fistula/etiology , Bronchial Fistula/surgery , Lung Neoplasms/surgery , Treatment Outcome , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: As a new technique developed in recent years, bronchoscopic intervention therapy has the advantages of minimal invasion, high safety and repeatability. The aim of this study is to investigate the clinical characteristics of bronchopleural fistula (BPF) induced by surgeries for lung malignancies or benign diseases and the effect of bronchoscopic intervention therapy for BPF, so as to provide support for prevention and treatment of BPF. METHODS: Data 64 patients with BPF who were treated by bronchoscopic intervention in Respiratory Disease Center of Dongzhimen Hospital, Beijing University of Chinese Medicine from June 2020 to September 2023 were collected. Patients with fistula diameter ≤5 mm were underwent submucous injection of macrogol, combined with blocking therapy with N-butyl cyanoacrylate, medical bioprotein glue or silicone prosthesis. Patients with fistula diameter >5 mm were implanted with different stents and cardiac occluders. Locations and characteristics of fistulas were summarized, meanwhile, data including Karnofsky performance status (KPS), shortbreath scale (SS), body temperature, pleural drainage volume and white blood cell count before and after operation were observed. RESULTS: For all 64 patients, 96 anatomic lung resections including pneumonectomy, lobectomy and segmentectomy were executed and 74 fistulas occurred in 65 fistula locations. The proportion of fistula in the right lung (63.5%) was significantly higher than that in the left (36.5%). Besides, the right inferior lobar bronchial fistula was the most common (40.5%). After operation, KPS was significantly increased, while SS, body temperature, pleural drainage volume and white blood cell count were significantly decreased compared to the preoperative values (P<0.05). By telephone follow-up or readmission during 1 month to 38 months after treament, median survival time was 21 months. 33 patients (51.6%) showed complete response, 7 patients (10.9%) showed complete clinical response, 18 patients (28.1%) showed partial response, and 6 patients (9.4%) showed no response. As a whole, the total effective rate of bronchoscopic intervention for BPF was 90.6%. CONCLUSIONS: BPF induced by pulmonary surgery can lead to severe symptoms and it is usually life-threating. Bronchoscopic intervention therapy is one of the fast and effective therapeutic methods for BPF.
Subject(s)
Bronchial Fistula , Lung Neoplasms , Pleural Diseases , Humans , Bronchial Fistula/etiology , Bronchial Fistula/surgery , Retrospective Studies , Lung Neoplasms/surgery , Lung Neoplasms/etiology , Pleural Diseases/etiology , Pleural Diseases/surgery , Pleura , Pneumonectomy/adverse effectsABSTRACT
Bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. Concomitant problems, such as pulmonary infection and respiratory failure, are typically the main contributors to mortality from BPF because of improper contact between the bronchial and pleural cavity. We present the case of a 75-year-old male patient with a history of right upper lobe lung cancer resection who developed complex BPFs. Following appropriate antibiotic therapy and chest tube drainage, we treated the fistulas using endobronchial valve EBV placement and local argon gas spray stimulation. Bronchoscopic treatment is the preferred method for patients who cannot tolerate a second surgery because it can help to maximize their quality of life. Our treatment method may be a useful reference for treating complex BPF.
Subject(s)
Bronchial Fistula , Pleural Diseases , Male , Humans , Aged , Quality of Life , Bronchoscopy/adverse effects , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/etiology , Bronchial Fistula/surgery , Pleural Diseases/diagnostic imaging , Pleural Diseases/etiology , Pleural Diseases/surgery , Anti-Bacterial Agents/therapeutic useABSTRACT
Bronchobiliary fistulas are defined as an abnormal communication between the biliary system and the bronchial tree. They are extremely rare complications of radiofrequency or microwave ablation. A 39-year-old woman with a history of neuroendocrine pancreatic carcinoma suffering from liver metastasis was treated with microwave ablation (MWA). In this case report, we present a case of intractable biliptysis from a bronchobiliary fistula secondary to an MWA. The patient was diagnosed by endoscopic retrograde cholangiopancreatograph and hepatobiliary scintigraphy. Treatment involved a right hemihepatectomy, a redo-hepaticojejunostomy, and the surgical placement of a transhepatic drain. After 6 weeks of drain placement, this could be removed. The fistula was thus successfully treated.
Subject(s)
Biliary Fistula , Bronchial Fistula , Liver Neoplasms , Humans , Female , Biliary Fistula/etiology , Biliary Fistula/diagnostic imaging , Biliary Fistula/surgery , Bronchial Fistula/etiology , Bronchial Fistula/diagnostic imaging , Adult , Liver Neoplasms/secondary , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/surgery , Treatment Outcome , Microwaves/therapeutic use , Microwaves/adverse effects , Hepatectomy , Drainage , Pancreatic Neoplasms/secondary , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathologyABSTRACT
Bronchopleural fistula (BPF), a sinus tract between the bronchial system and the pleural space, is associated with COVID-19 and can lead to pneumothorax, which increases the mortality rate. Due to the analytical status of COVID-19 patients, sealing the BPF necessitates the least minimal invasive treatment. Herein, we demonstrated a technique of sealing post-COVID-19 BPF with direct injection of cyanoacrylate glue under the guidance of a computed tomography scan. Following glue injection, the BPF was completely sealed in all four patients. In conclusion, in COVID-19 patients with small and distal BPF, percutaneous glue injection is recommended for BPF closure.
Subject(s)
Bronchial Fistula , COVID-19 , Pleural Diseases , Humans , Cyanoacrylates/pharmacology , Cyanoacrylates/therapeutic use , COVID-19/complications , Bronchial Fistula/therapy , Pleural Diseases/therapy , Tomography, X-Ray ComputedABSTRACT
Bronchopleural fistula (BPF) with empyema caused by severe necrotizing pulmonary infection is a complicated clinical problem that is often associated with poor general condition so surgical interventions cannot be tolerated in most cases. Here, we present the successful management of multiple BPF with empyema in a mechanically ventilated patient with aspiration lung abscess. Occlusion utilizing Gelfoam followed by endobronchial valves (EBVs) implanted inverted via bronchoscope decreased the air leaking significantly and made intrapleural irrigation for empyema achievable and safe. This is the first report of a novel way of EBV placement and the combination use with other occlusive substances in BPF with empyema in a patient on mechanical ventilation. This method may be an option for refractory BPF cases with pleural infection.