RESUMO
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.
Assuntos
Fístula Brônquica , Doenças Pleurais , Masculino , Humanos , Idoso , Qualidade de Vida , Broncoscopia/efeitos adversos , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/etiologia , Doenças Pleurais/cirurgia , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: Broncho-esophageal fistula (BEF) secondary to esophageal diverticulum is a rare clinical condition, which is often misdiagnosed for a long time. The aim of our study is to summarize and clarify the advantages of MSCT in diagnosing BEF secondary to esophageal diverticulum. METHODS: We retrospectively analyzed patients clinically diagnosed with BEF from January 2005 to January 2022 at Jilin University First Hospital. Only those patients with BEF secondary to esophageal diverticulum and complete clinical data met our enrolled standard. All patients' clinicopathologic characteristics and MSCT features were systemically evaluated. RESULTS: 17 patients were eligible for our cohort study, including male 10 and female 7. The patient's mean age was 42.3 ± 12.5. The chronic cough occurred in all seventeen patients and bucking following oral fluid intake was documented in nine patients. MSCT distinctly suggested the fistulous tract between the bronchi and the esophagus in all patients. The mean diameter of the orifices in the wall of the esophagus was 4.40 ± 1.81 mm. The orifice in the midthoracic esophagus side was 15 cases and 2 cases at the lower thoracic esophagus. The involved bronchus included 13 cases at the right lower lobe bronchus, 1 at the right middle lobe bronchus and 3 at the left lower lobe bronchus. The contrast agent was observed in the pulmonary parenchyma in 10 of 13 patients who underwent esophagogram. No definite fistula was observed in 3 of 11 who underwent gastroscopy, while the intra-operative findings supported the existence of fistula. CONCLUSIONS: BEF secondary to esophageal diverticulum tends to occur between the midthoracic esophagus and the right lower lobe bronchus. Compared with esophagography and gastroscopy, MSCT shows more comprehensive information about the fistulous shape, size, course and lung involvement, which are helpful for establishing diagnosis and guiding subsequent treatment.
Assuntos
Fístula Brônquica , Divertículo Esofágico , Fístula Esofágica , Adulto , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos de Coortes , Divertículo Esofágico/diagnóstico , Divertículo Esofágico/diagnóstico por imagem , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgiaAssuntos
Fístula Brônquica , Abscesso Pulmonar , Doenças Pleurais , Humanos , Abscesso Pulmonar/complicações , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/cirurgia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Doenças Pleurais/complicações , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/cirurgia , Pulmão , PneumonectomiaRESUMO
Coronary fistulas are unusual finding in coronary angiography (CAG) with coronary bronchial fistula (CBF) being a rarer one. Here, we represent a case of CBF which was diagnosed incidentally on CAG. These anomalous connections can be percutaneously treated.
Assuntos
Fístula Brônquica , Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Humanos , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Achados Incidentais , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Angiografia CoronáriaAssuntos
Doenças da Aorta , Fístula Brônquica , Fístula , Fístula Vascular , Humanos , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Hemoptise , Aorta Torácica/diagnóstico por imagemAssuntos
Fístula Biliar , Fístula Brônquica , Embucrilato , Humanos , Embucrilato/uso terapêutico , Colangiografia , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/terapia , Endoscopia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/terapia , Colangiopancreatografia Retrógrada EndoscópicaRESUMO
BACKGROUND: Pleuropulmonary amebiasis is the second most common form of extraintestinal invasive amebiasis, but cases that include bronchopleural fistula are rare. CASE PRESENTATION: A 43-year-old male was referred to our hospital for liver abscess, right pleural effusion, and body weight loss. He was diagnosed with a bronchopleural fistula caused by invasive pleuropulmonary amebiasis and human immunodeficiency virus (HIV) infection. After initial medical treatment for HIV infection and invasive amebiasis, he underwent pulmonary resection of the invaded lobe. Intraoperative inspection revealed a fistula of the right basal bronchus in the perforated lung abscess cavity, but the diaphragm was intact. The patient was discharged on postoperative day 3 and was in good condition at the 1-year follow-up. CONCLUSIONS: Clinicians should be aware that pleuropulmonary amebiasis can cause a bronchopleural fistula although it is very rare.
Assuntos
Amebíase , Fístula Brônquica , Infecções por HIV , Doenças Pleurais , Derrame Pleural , Masculino , Humanos , Adulto , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Infecções por HIV/complicações , Amebíase/complicações , Amebíase/diagnóstico , Doenças Pleurais/complicações , Doenças Pleurais/cirurgiaAssuntos
Fístula Brônquica , Doenças Pleurais , Humanos , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/etiologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologiaAssuntos
Fístula Biliar , Fístula Brônquica , Volvo Gástrico , Humanos , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Fístula Biliar/complicações , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/cirurgia , Fístula Brônquica/complicações , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/cirurgiaRESUMO
Bronchobiliary fistula (BBF) is an abnormal connection between the bronchial system and the biliary tree. It pathognomonically presents with bilioptysis (production of bilious-tinged sputum) and is associated with mortality rates up to 12.7%. Here we present a 56-year-old male with stage IV neuroendocrine pancreatic cancer status post pylorus-preserving pancreaticoduodenectomy. The patient developed an acquired BBF secondary to repeated Yttrium-90 radioembolization therapy that resulted in complete stenosis of the hepaticojejunostomy (HJ) anastomosis. The diagnosis was confirmed using cholescintigraphy and bronchoscopy. Biliary decompression with percutaneous transhepatic cholangiogram was unsuccessful, necessitating resection of the HJ anastomosis with salvage bilioenteric reconstruction using Kasai-type anastomosis between the pancreaticobiliary limb and hepatic duct. Complete resolution was noted following surgery. Although a minimally invasive approach to treatment of BBF may be favorable, patients with previous biliary reconstruction may warrant multimodal treatments including percutaneous procedures and complex surgical reconstructions.
Assuntos
Fístula Biliar , Fístula Brônquica , Humanos , Pessoa de Meia-Idade , Constrição Patológica , Fígado/cirurgia , Vesícula Biliar/cirurgia , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Anastomose Cirúrgica/efeitos adversosRESUMO
BACKGROUND: Bronchobiliary fistula is a rare and complex entity defined by an abnormal communication between the biliary and bronchial systems. The etiopathogenesis is not completely understood, but the most common factors implicated are hepatobiliary tumors, biliary obstruction, iatrogenic damage or trauma. METHODS: Here we present a case of a 69-year-old man that developed a bronchobiliary fistula and a pulmonary abscess after migration of a bile duct stent placed as part of the treatment of an iatrogenic bile duct injury that occurred during elective cholecystectomy. RESULTS: A conservative approach, that included broad-spectrum antibiotic, removal of the stent, and sphincterotomy, was enough for the closure of the fistula and resolution of the symptoms. CONCLUSION: We emphasize the importance of prompt recognition of this entity and a concerted therapeutic strategy to optimize the probability of success, avoiding the destructive consequences of the bile in the pulmonary parenchyma and septic complications.