Bronchopleural fistula and tension pneumothorax after pneumonectomy

Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including re-expansion pulmonary edema.

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Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports

BMC Pediatrics ◽

10.1186/s12887-019-1783-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Anna Rieth ◽

Tamás Kovács ◽

Zoltán Novák ◽

Katalin Kapus ◽

Aurél Ottlakán ◽

...

Keyword(s):

Computed Tomography ◽

Conservative Treatment ◽

Inflammatory Markers ◽

Late Onset ◽

Case Reports ◽

Bronchopleural Fistula ◽

Tension Pneumothorax ◽

Safe Alternative ◽

Chest Computed Tomography ◽

Initial Symptoms

Abstract Background Aspiration of grass inflorescences is an extremely rare phenomenon with potential diagnostic difficulties. Due to its special shape, each coughing and respiratory action helps its migration towards the periphery of lung, resulting late-onset, life-threatening complications. The diagnosis has some difficulties for the reason that soon after the aspiration initial symptoms, such as coughing, wheezing or vomiting disappear and bronchoscopy is mostly negative. At least serious complications such as tension pneumothorax, bronchopleurocutaneous fistula or even spontaneous percutan elimination may develope. Case presentation We present two cases of pleuropneumonia resulting from aspiration of the head of barley grass. Soon after the accidents initial symptoms diminished, inflammatory markers improved and bronchoscopy was unable to confirm the presence of awn. Despite of conservative treatment (antibiotics, physiotherapy, bronchodilators, expectorants, and inhalation) localized pulmonary inflammation developed after 1 and 9 months showed up on chest computed tomography. After ineffective conservative treatment, surgical resections became inevitable in order to remove chronically inflamed parts (lobectomy, segmentectomy) and foreign bodies. Both patients recovered and were discharged home after successful interventions. Conclusions Due to its peculiar shape and behaviour, awn inhalation is a special and atypical form of aspiration, thus great care and awareness is needed in its treatment. Negative bronchoscopic result does not exclude the presence of bronchial grass head. Symptomless child with negative bronchoscopy and improved inflammatory markers should be followed up thoroughly to recognize late complications in time. Regular diagnostic steps (chest ultrasound/X-ray) should be performed to localize potential chronic lung inflammation. Chest computed tomography is a valuable diagnostic tool for identifying and localising the foreign body. In cases with localized inflammation and peripheric localisation, segmentectomy can be a successful and safe alternative of lobectomy.

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Bronchopleural Fistula associated Tension Pneumothorax in SARS- COVID 19: A case report

10.22541/au.163809451.15247047/v1 ◽

2021 ◽

Author(s):

Milan Regmi ◽

Moon Shrestha ◽

Nibesh Pathak ◽

Niraj Sharma ◽

Pankaj Pant

Keyword(s):

Case Report ◽

Unusual Case ◽

Bronchopleural Fistula ◽

Tension Pneumothorax

COVID-19 can cause pneumothorax but pneumothorax in COVID-19 patient associated with bronchopleural fistula is very rarely reported. We present this unusual case of Tension Pneumothorax in COVID -19 Patient associated with Bronchopleural Fistula.

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Unrecognised Suction Failure Causing Tension Pneumothorax

Journal of the Intensive Care Society ◽

10.1177/175114371001100210 ◽

2010 ◽

Vol 11 (2) ◽

pp. 124-125

Author(s):

Simon Helling ◽

Steve Benington ◽

Daniel Conway

Keyword(s):

Closed System ◽

Bronchopleural Fistula ◽

Tension Pneumothorax ◽

Chest Drain ◽

Wall Suction

We present the case of a patient who developed a bronchopleural fistula, which was treated with the use of a chest drain with application of suction. The patient significantly deteriorated clinically and developed a tension pneumothorax. After some delay, the wall suction unit was found to be blocked, thereby creating a closed system and causing a pneumothorax under tension. We discuss the safe application of suction to chest drains with particular reference to the use of the three-bottle system.

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Persistent air leak (bronchopleural fistula) in neonates

Journal of Pediatrics & Neonatal Care ◽

10.15406/jpnc.2021.11.00441 ◽

2021 ◽

Vol 11 (3) ◽

pp. 35-38

Author(s):

Sunita Ojha ◽

Goutam Sen ◽

Rajiv Bansal ◽

Anupam Chaturvedi ◽

Mahaveer Saini

Keyword(s):

Cardiac Arrest ◽

Chest Tube ◽

Case Reports ◽

Bronchopleural Fistula ◽

Tension Pneumothorax ◽

Air Leak ◽

Tube Insertion ◽

Mortality And Morbidity ◽

Chest Tube Insertion ◽

Persistent Air Leak

Background: Pneumothorax is a known complication in neonates on ventilation but persistent air leak is infrequently seen in neonates and is troublesome to manage. Persistent air leak on chest tube insertion is suggestive of bronchopleural fistula, often resulting in significant mortality and morbidity. Various modalities of management like multiple chest tube insertions (thoracostomies), selective bronchial occlusion, pleurodesis using talc, tetracycline etc and urgent surgery to repair the leak have been mentioned. Islolated case reports for management of bronchopleural fistula in neonates are abound in literature but consensus and attention should be directed to improve awareness and access to clinical guidelines in management of bronchopleural fistula in neonates. Methods: Our aim was to evaluate the management and outcome of neonates with persistent air leak (bronchopleural fistula). Result: Eighteen neonates with bronchopleural fistula (BPF) were managed from 2012-2018. All neonates were managed by chest tube insertion, and slow suction (10-15cm of H2O). In those patients having persistent pneumothorax despite functioning tube with persistent air leak, second chest tube was inserted in 2nd intercostal space. Five of these patients even had cardiac arrest due to tension pneumothorax but were revived. One neonate required pleurodesis, two expired and remaining improved on multiple chest tube insertion and were discharged. None required selective bronchial intubation or surgery. Conclusion: Tension pneumothorax with persistent air leak on chest tube suggestive of Broncho-pleural fistula is a difficult and a rare problem in neonates. If not timely taken care of it can lead to cardiac arrest but despite cardiac arrest aggressive resuscitation and judicious use of multiple chest tube drainage and slow suction can help these little patients improve.

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Stepwise multidisciplinary approach in very low birthweight infant with bronchopleural fistula

BMJ Case Reports ◽

10.1136/bcr-2021-241721 ◽

2021 ◽

Vol 14 (7) ◽

pp. e241721

Author(s):

Anna Milan ◽

Iain Yardley ◽

Grenville Fox ◽

Virginie Meau-Petit

Keyword(s):

Multidisciplinary Approach ◽

Low Birthweight ◽

Main Bronchus ◽

Bronchopleural Fistula ◽

Tension Pneumothorax ◽

Lung Ventilation ◽

Chest Drain ◽

Very Low Birthweight ◽

Surgical Teams ◽

Very Low Birthweight Infant

A 25-week gestation infant experienced chest infection complicated by septic shock and tension pneumothorax. Despite multiple drains, it was impossible to reinflate the lung, thus suggesting a bronchopleural fistula. Multidisciplinary meetings were arranged, involving the parents, and a stepwise approach was agreed. Chest drain repositioning, single lung ventilation and pleurodesis proved unsuccessful. In a rare window of relative stability, open chest surgery was performed at the cot-side by the paediatric general and cardiothoracic surgical teams. A large tear was identified at the carina, extending along the left main bronchus. This was repaired, with immediate clinical improvement. He was extubated 7 days later and discharged home on day 94 (CGA 39+0). This case report describes a successful stepwise multidisciplinary approach to a bronchopleural fistula in a very low birthweight infant, highlighting the potential for surgical intervention at cot-side and the value of involving the surgical team early on.

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A pneumatocele observed in the thoracic cavity after bronchoalveolar lavage

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1412 ◽

2021 ◽

Vol 2 (6) ◽

Author(s):

Satoshi Tanaka ◽

◽

Riiko Kitou ◽

Kiyohide Komuta ◽

Satoshi Tanizaki ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Bronchopleural Fistula ◽

Tension Pneumothorax ◽

Check Valve ◽

Thoracic Cavity ◽

Exertional Dyspnea ◽

Severe Condition ◽

Cryptogenic Organizing Pneumonia ◽

First Case ◽

Secondary Infections

A 76-year-old man was admitted to the respiratory medicine department with 5 days of a non-productive cough and exertional dyspnea. A computed tomography revealed multiple mild patchy consolidations in both lungs (Figure 1). Despite antibiotic therapy, there was poor improvement in laboratory and radiological parameters. A bronchoscopy was performed on day 5. The bronchoscopy was wedged in left B5 and a bronchoalveolar lavage (BAL) was performed. After the BAL, we noticed a fistula in the depth of left B5 and saw a structure like a pleural cavity in the back of the fistula (Figure 2). We diagnosed the patient’s condition as pneumatocele (PC). BAL showed 46% lymphocytes and the CD4/8 ratio as 3:7. These findings suggested cryptogenic organizing pneumonia (COP). It took 3 weeks for the PC to improve. Bilateral multiple consolidations improved after the administration of a steroid (PSL 0.5 mg/kg). PCs can occur in infections, chest trauma, barotrauma from mechanical ventilation, and bronchial interventions [1,2]. The mechanism of PC formation is closely related to that of a check valve. The check valve may be composed of exudate from inflammation and the destroyed wall of the respiratory tract [3]. In this case, it was considered that the wedged bronchoscopy and collapsed bronchial wall became the check-valve. PCs can be a severe condition including tension pneumothorax, bronchopleural fistula, and secondary infections [4]. In our case, as we were concerned about new complications due to the PC we did not prescribe a steroid for COP until the PC had improved. To our knowledge, no papers have reported internal observations of PC. We herein report the first case of PC observed in the thoracic cavity after BAL.

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Chronic Tension Pneumothorax Presumably Due to a “Ball Valve” Bronchopleural Fistula

Southern Medical Journal ◽

10.1097/00007611-198604000-00031 ◽

1986 ◽

Vol 79 (4) ◽

pp. 510-512 ◽

Cited By ~ 1

Author(s):

WILLIAM W. WOODRUFF ◽

JORGE L. GAMBA ◽

CHARLES E. PUTMAN ◽

JAMES T. T. CHEN

Keyword(s):

Bronchopleural Fistula ◽

Tension Pneumothorax ◽

Ball Valve

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Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

BMJ Case Reports ◽

10.1136/bcr-2020-235281 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235281

Author(s):

Sanjan Asanaru Kunju ◽

Prithvishree Ravindra ◽

Ramya Kumar Madabushi Vijay ◽

Priya Pattath Sankaran

Keyword(s):

Tension Pneumothorax ◽

Emergency Laparotomy ◽

Severe Respiratory Distress ◽

Mediastinal Shift ◽

Breath Sounds ◽

Chest X Ray ◽

The Right ◽

Tension Gastrothorax ◽

Obstructive Shock ◽

Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

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Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz287 ◽

2019 ◽

Author(s):

Alessandro Brunelli ◽

Gaetano Rocco ◽

Zalan Szanto ◽

Pascal Thomas ◽

Pierre Emmanuel Falcoz

Keyword(s):

Neoadjuvant Chemotherapy ◽

Propensity Score ◽

Propensity Score Analysis ◽

Bronchopleural Fistula ◽

Neoadjuvant Treatment ◽

Mortality Rates ◽

Induction Treatment ◽

Score Analysis ◽

Cardiopulmonary Complications ◽

Lung Resections

Abstract OBJECTIVES To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. METHODS Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007–31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. RESULTS 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). CONCLUSIONS Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

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