[A case of accessory cardiac bronchus with acute empyema treated by open drainage]

A 40-year-old man was admitted to the hospital because of acute empyema localized in the right lower posterior pleural space. The conservative treatment with antibiotics for one month failed to show any clinical improvement. Surgical intervention, therefore, was required. Broncho-fiberscopic and bronchographic findings prior to open drainage revealed a supernumerary bronchus with inflammatory sign on the right intermediate bronchus and a small sprig like bronchial fistula attached to the tip of the abnormal bronchus. The operation induced the swift alleviation of empyema and the disappearance of bronchial inflammation. From the location of empyema and the disappearance of bronchial inflammation associated with the improvement of clinical findings, the infection of the abnormal bronchus was thought as a main cause of empyema. Empyema caused by this kind of abnormality is extremely rare and no similar case has been reported in the literature to our knowledge. Some pathological problems of the abnormal bronchus were discussed and 54 cases of accessory cardiac bronchus reported in Japan were reviewed.