Development of alveolar-pleural fistula during hepatectomy - A case report

An Alveolar-pleural fistula is communication between the alveoli and the pleural space that may result in intractable pneumothorax, severe infection, respiratory failure, physical weakness, and even death.

A 70-year-old male underwent right hepatectomy with a cystic mass of the liver. During the operation, peak airway pressure abruptly increased and a serous fluid was regurgitated through the endotracheal tube. Lung isolation was immediately performed with a double-lumen endotracheal tube. Approximately 1,000 ml of exudate was drained through endotracheal tube. Thoracostomy was performed at right lung. Analysis of fluid from endotracheal tube and pleural effusion consistent with parapneumonic effusion.

We presented a case of alveolar-pleural fistula caused by pneumonia presenting with massive exudate fluid regurgitated from the endotracheal tube that was managed with bronchial suction, lung isolation, and thoracostomy and improved without surgical repair of the fistula.