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Delayed closure of persistent postpneumonectomy bronchopleural fistula
Dale K Mueller1, Patrick E Whitten, William P Tillis
1Illinois Cardiac Surgery Associates and University of Illinois College of Medicine at OSF St. Francis Medical Center, Peoria, IL 61603, USA.
Chest
|May 15, 2002
Summary
A patient with a long-term chest tube developed a bronchopleural fistula and pneumonia. Surgical closure of the fistula and antibiotic treatment resolved the infection.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Infectious Diseases
Background:
- A 73-year-old male with a history of postpneumonectomy empyema and a chronic chest tube presented with symptoms of infection.
- The patient had a long-standing chest tube in place since 1979 for management of empyema.
Observation:
- The patient presented with fever, chills, leukocytosis, and purulent drainage from his left tube thoracostomy.
- Imaging (CT scan) and bronchoscopy revealed right lower lobe pneumonia and a left mainstem dehiscence.
- The dehiscence created a direct communication between the airway and the left tube thoracostomy.
Findings:
- The patient was treated with antibiotics for the right lower lobe pneumonia.
- A surgical intervention was performed for primary closure of the bronchopleural fistula.
- The fistula was covered using a latissimus dorsi muscle flap.
Implications:
- This case highlights the complex management of chronic empyema complications.
- Successful surgical repair of a bronchopleural fistula in this context is feasible.
- Multidisciplinary approach involving infectious disease, pulmonary, and thoracic surgery is crucial.