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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.

The Journal of the Louisiana State Medical Society : Official Organ of the Louisiana State Medical Society

|May 16, 2015

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.

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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.

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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.