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Broken lung
Ikrita K Klair1, Jaime Palomino1, Fayez Kheir1
1Department of Pulmonary Diseases, Critical Care, and Environmental Medicine at the Tulane University School of Medicine in New Orleans.
Summary
This case report details a rare, large bronchopleural fistula (BPF) measuring 30 mm, complicating severe acute respiratory distress syndrome (ARDS). Persistent air leaks after chest tube placement may indicate BPF.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Radiology
Background:
- Acute respiratory distress syndrome (ARDS) presents significant clinical challenges.
- Bronchopleural fistulas (BPFs) are abnormal connections between the bronchial tree and pleural space, often complicating lung diseases or thoracic procedures.
- Diagnosis and management of BPFs, especially large ones, require careful consideration.
Observation:
- A case of severe ARDS is presented.
- The patient developed a very large bronchopleural fistula (BPF), measuring 30 mm.
- The BPF was clearly visualized on a computed tomography (CT) chest scan.
Findings:
- A 30 mm BPF is exceptionally large, as BPFs >6 mm are generally considered large.
- Large BPFs can be readily identified on CT scans.
- Persistent air leak despite chest tube intervention is a key indicator for suspecting BPF.
Implications:
- This case highlights the rare but significant complication of large BPFs in ARDS.
- Radiological identification of BPFs is crucial for timely diagnosis.
- Clinical suspicion, guided by persistent air leak, is vital for detecting BPFs that might be missed on imaging.