Imaging the Post-Thoracotomy Patient

Alpert, Jeffrey B.; Godoy, Myrna C.B.; DeGroot, Patricia M; Truong, Mylene T.; Ko, Jane P.

doi:10.1016/j.rcl.2013.08.008

Cited by 45 publications

(14 citation statements)

References 63 publications

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“…The routine postoperative follow-up CT examination does not expose patients to the additional invasive study, unlike bronchoscopy. Traditional CT and dual-energy CT applications should be expanded to image the anatomic changes and related complications for post-lobectomy patient [5, 7].…”

Section: Discussionmentioning

confidence: 99%

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Structural and functional alterations of the tracheobronchial tree after left upper pulmonary lobectomy for lung cancer

Yue

et al. 2019

BioMed Eng OnLine

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BackgroundPulmonary lobectomy has been a well-established curative treatment method for localized lung cancer. After left upper pulmonary lobectomy, the upward displacement of remaining lower lobe causes the distortion or kink of bronchus, which is associated with intractable cough and breathless. However, the quantitative study on structural and functional alterations of the tracheobronchial tree after lobectomy has not been reported. We sought to investigate these alterations using CT imaging analysis and computational fluid dynamics (CFD) method.MethodsBoth preoperative and postoperative CT images of 18 patients who underwent left upper pulmonary lobectomy are collected. After the tracheobronchial tree models are extracted, the angles between trachea and bronchi, the surface area and volume of the tree, and the cross-sectional area of left lower lobar bronchus are investigated. CFD method is further used to describe the airflow characteristics by the wall pressure, airflow velocity, lobar flow rate, etc.ResultsIt is found that the angle between the trachea and the right main bronchus increases after operation, but the angle with the left main bronchus decreases. No significant alteration is observed for the surface area or volume of the tree between pre-operation and post-operation. After left upper pulmonary lobectomy, the cross-sectional area of left lower lobar bronchus is reduced for most of the patients (15/18) by 15–75%, especially for 4 patients by more than 50%. The wall pressure, airflow velocity and pressure drop significantly increase after the operation. The flow rate to the right lung increases significantly by 2–30% (but there is no significant difference between each lobe), and the flow rate to the left lung drops accordingly. Many vortices are found in various places with severe distortions.ConclusionsThe favorable and unfavorable adaptive alterations of tracheobronchial tree will occur after left upper pulmonary lobectomy, and these alterations can be clarified through CT imaging and CFD analysis. The severe distortions at left lower lobar bronchus might exacerbate postoperative shortness of breath.

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Section: Discussionmentioning

confidence: 99%

“…The high-resolution computed tomography (CT) images are used for the anatomic alterations and postoperative complications [5–7]. Ueda et al initially reported that bronchial kink was found in 42% (21/50) of the patients and bronchial kink may exacerbate the postoperative deterioration of lung function [4].…”

Section: Introductionmentioning

confidence: 99%

Structural and functional alterations of the tracheobronchial tree after left upper pulmonary lobectomy for lung cancer

Yue

et al. 2019

BioMed Eng OnLine

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“…Postoperative consequences include structural modifications in the thoracic space: the hemithoracic volume on the side of surgery decreases, the hemidiaphragm rises upward, and the mediastinum shifts towards the lobectomy side. 1,2 Such displacements determine deformity of the residual structures, which could lead to bronchial kinking and/or obstruction of the airways in severe cases. [2][3][4][5] These alterations could further reduce pulmonary function, which is already compromised by the permanent loss of respiratory tissue and by possible existing comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Computational fluid dynamics of the airways after left‐upper pulmonary lobectomy: A case study

Tullio

Aliboni

Pennati

et al. 2021

Numer Methods Biomed Eng

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Pulmonary lobectomy is the gold standard intervention for lung cancer removal and consists of the complete resection of the affected lung lobe, which, coupled with the re-adaptation of the remaining thoracic structures, decreases the postoperative pulmonary function of the patient. Current clinical practice, based on spirometry and cardiopulmonary exercise tests, does not consider local changes, providing an average at-the-mouth estimation of residual functionality. Computational Fluid Dynamics (CFD) has proved a valuable solution to obtain quantitative and local information about airways airflow dynamics. A CFD investigation was performed on the airway tree of a leftupper pulmonary lobectomy patient, to quantify the effects of the postoperative alterations. The patient-specific bronchial models were reconstructed from pre-and postoperative CT scans. A parametric laryngeal model was merged to the geometries to account for physiological-like inlet conditions. Numerical simulations were performed in Fluent. The postoperative configuration revealed fluid dynamic variations in terms of global velocity (+23%), wall pressure (+48%), and wall shear stress (+39%). Local flow disturbances emerged at the resection site: a high-velocity peak of 4.92 m/s was found at the left-lower lobe entrance, with a local increase of pressure at the suture zone (18 Pa). The magnitude of pressure and secondary flows increased in the trachea and flow dynamics variations were observed also in the contralateral lung, causing altered lobar ventilation. The results confirmed that CFD is a patient-specific approach for a quantitative evaluation of fluid dynamics parameters and local ventilation providing additional information with respect to current clinical approaches. K E Y W O R D Scomputational fluid dynamics, imaged-based, pulmonary lobectomy, tracheobronchial tree modeling Marta Tullio and Lorenzo Aliboni equally contributed to this study.

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“…The most common occurrence of bronchopleural fistula is as a postoperative complication after a pneumonectomy or lobectomy [ 1 ]. By removing the entire lung or a lobe a conduit may be created between the end of the bronchus and the pleural space.…”

Section: Discussionmentioning

confidence: 99%

“…Bronchopleural fistula formation is a rare complication of lobectomy surgery, with a frequency reported ranging from 0.5% to 1% [ 1 ]. A post-lobectomy bronchopleural fistula usually presents within 14 days of surgery.…”

Section: Introductionmentioning

confidence: 99%

Development of Bronchopleural Fistula Complicated by Empyema Fifteen Years After Right Lower Lobe Lobectomy: A Case Report

2020

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Patient: Male, 55-year-old Final Diagnosis: Bronchopleural fistula • empyema Symptoms: Back pain • productive cough • shortness of breath Medication:— Clinical Procedure: Bronchoscopy • chest wall resection • laparotomy • omentectomy • thoracentesis • thoracotomy Specialty: Microbiology and Virology • Pulmonology • Surgery Objective: Unusual clinical course Background: Bronchopleural fistula formation is a rare complication of lobectomy surgery, with a frequency reported ranging from 0.5% to 1%. A post-lobectomy bronchopleural fistula usually presents within 14 days of surgery. To our knowledge, it is extremely rare for a bronchopleural fistula to develop many years after an operation. Case Report: We present the case of a 55-year-old male smoker with history of a right lower lobe lobectomy 15 years prior who presented to the Emergency Department with complaints of worsening back pain, shortness of breath, and cough productive of sputum. He was found to have a right bronchopleural fistula with right-sided empyema. He was taken to the operating room a few days after initial admission for right thoracoscopic chest exploration, right chest debridement, right chest wall resection, and window procedure with creation of pleuro-cutaneous fistula. Ultimately, he required a right completion pneumonectomy and buttress of bronchial stump with transdiaphragmatic omental flap. Conclusions: We diagnosed a rare case of post-lobectomy bronchopleural fistula complicated by an empyema that demonstrates bronchopleural fistulas can appear 15 years postoperatively and present with subacute clinical signs and symptoms.

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Imaging the Post-Thoracotomy Patient

Cited by 45 publications

References 63 publications

Structural and functional alterations of the tracheobronchial tree after left upper pulmonary lobectomy for lung cancer

Structural and functional alterations of the tracheobronchial tree after left upper pulmonary lobectomy for lung cancer

Computational fluid dynamics of the airways after left‐upper pulmonary lobectomy: A case study

Development of Bronchopleural Fistula Complicated by Empyema Fifteen Years After Right Lower Lobe Lobectomy: A Case Report

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