An 83-year-old-male with bronchopleural fistula and empyema successfully treated with multidisciplinary management of thoracostomy, endoscopic, and surgical treatment: a case report

Abstract

Bronchopleural fistula (BPF) with empyema is a severe complication in patients undergoing lobectomy or pneumonectomy and is associated with high morbidity and mortality rates. Although a wide variety of treatment options exist, refractory cases with larger fistulas are still difficult to cure, especially in elderly patients. Here, we report a case of an 83-year-old man with stage I squamous cell lung carcinoma who underwent minimally invasive right lower lobectomy. After an initially uneventful postoperative course, he was readmitted to our hospital due to the progression of severe cough with fever after lung resection. Chest computed tomography (CT) showed an empyema cavity containing pleural effusion and a drainage tube in the right lower thorax. Bronchoscopy confirmed the presence of a fistula between the right lower bronchial stump and the pleural cavity. On the basis of his clinical symptoms and these imaging findings, the patient was diagnosed with BPF with empyema after lobectomy. He was successfully treated with multidisciplinary management including adequate pleural drainage by open-window thoracostomy, closure of the BPF by endoscopic therapy using an Amplatzer device, and complete obliteration of the empyema cavity with pedicled muscle flap. Multidisciplinary management combining thoracostomy, endoscopic therapy, and pedicled muscle flap transfer is a safe and effective treatment for elderly patients with larger fistulas and empyema.

Autologous myocutaneous flap implantation for chronic refractory chest wall sinus with infection: a case report

“…After operation, the color of the skin paddle can be observed regularly and the blood supply can be understood in time.Tissue aps commonly used in clinic include muscle ap, myocutaneous ap, greater omentum and so on [9,10].In order to eliminate the chest wall tissue defect caused by debridement, increase local blood supply, improve local tissue healing and anti infection ability are very important. For patients with large tissue defect after debridement, pedicled myocutaneous ap with good blood supply should be used to ll the chest wall defect [11,12].Since the patient has undergone total mastectomy for breast cancer, and the nearby pectoralis major muscle and surrounding tissues are weak, we chose the latissimus dorsi myocutaneous ap with close anatomical location and abundant blood supply to repair the huge chest wall defect [13,14].…”

Salvage treatment of acute respiratory failure after autogenous tissue flap transplantation for chronic empyema with chest wall sinus: a case report and literature review

“…The treatment of chronic empyema with chest wall sinus is very complicated, especially those caused by post-pneumonectomy. Some patients even include a huge abscess cavity due to the inconspicuous collapse of the affected side of the chest,which often leads to poor infection control, more complications, and a high mortality rate [ 1 – 3 ]. These often require comprehensive treatment methods, including technique of thoracoplasty, management of BPF and abscess cavity, degree of infection control, and optimization of general conditions [ 4 ].…”

Salvage Treatment of Acute Respiratory Failure after Transcomposite Myocutaneous Flaps Transplantation for Chronic Empyema Combined with Chest Wall Sinus: A Case Report

“…The treatment of chronic empyema with chest wall sinus is complicated, especially empyema caused by postpneumonectomy,Some patients even contain a huge purulent cavity because the collapse of the chest is not obvious on the affected side,which often results in poor infection control, more complications, and high mortality (1)(2).These often require comprehensive treatment methods, including the management of bronchopleural stula (BPF) and thoracic cavity, the degree of infection control, and the optimization of general conditions (3).The compound myocutaneous ap is used to treat chronic empyema with a huge empyema cavity. After the operation, it mainly prevents the occurrence of vascular crisis between the donor and the recipient.Among the operation-related complications, the incidence of acute respiratory failure caused by aspiration pneumonia is not high.…”