Completion pneumonectomy and thoracoplasty for bronchopleural fistula and fungal empyema

Achieving sterilization of the postpneumonectomy space and bronchial healing may be difficult when active granulomatous infection of the pleural space and lung parenchyma is present at the time of operation. Three patients with chronic bronchopleural fistula, fungal empyema, and fungal cavities of the remaining ipsilateral lobe were managed with one-stage completion pneumonectomy and modified eight-rib thoracoplasty. Two patients had infection with Aspergillus fumigatis and 1 patient had Coccidioides immitis. Two patients had received mediastinal radiation after prior upper lobectomy for carcinoma of the lung. Two patients were having massive hemoptysis at the time of pneumonectomy. Eight-rib thoracoplasty with suturing of the intercostal muscles to the bronchial stump was performed on all patients. In 2 patients a mass closure of hilar vessels and bronchus was used because of inability to individually close the vessels and bronchus due to ligneous scarring of the hilum. Antibiotic and antifungal irrigations into the operative area were used postoperatively. Chest tubes were left in place 6 to 8 weeks. All wounds healed primarily. Patients were alive without recurrent local infection or tumor at follow-up 3 to 13 years postoperatively.