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Turk Kardiyoloji Dernegi Arsivi : Turk... Dec 2021A coronary-to-pulmonary-artery fistula (CPAF) is defined as a connection between the coronary arteries and the pulmonary arteries (PAs). Invasive treatment options for...
A coronary-to-pulmonary-artery fistula (CPAF) is defined as a connection between the coronary arteries and the pulmonary arteries (PAs). Invasive treatment options for CPAFs include surgical ligation and transcatheter coil or plug embolization. A 60-year-old female patient was referred to our hospital with symptoms of exercise-induced angina (Canadian Cardiovascular Society Class III [CCS-3]). Her relevant history included elective stenting of the left anterior descending (LAD) artery in 2013 and surgery for an LAD to PA fistula in 2015. Upon recurrence of the same fistula in 2017, she underwent a failed antegrade (from LAD to PA) attempt for percutaneous closure of the fistula. A retrograde approach was decided because of the extensive tortuosity of the fistula's proximal part that led to the previous failed attempt and the likelihood of ceasing whole blood flow at the fistula's distal neck. Through right femoral venous access, we advanced a 5 Fr. 45 cm TorqVue low-profile delivery system (St. Jude Medical, Little Canada, MN, USA) over a J-tip 0.035-inch guidewire to the PA. The antegrade imaging guidance enabled us to advance the guidewire to the distal neck of the fistula retrogradely. As the distal part of the fistula was similar to a tunnel-shaped patent ductus arteriosus (PDA) and was measured 4 mm at the narrowest diameter, we opted for an Amplatzer duct occluder II 6 × 6 (Abbott Vascular, Chicago, IL, USA) to close it.
Topics: Angina Pectoris; Arterio-Arterial Fistula; Cardiac Catheterization; Computed Tomography Angiography; Coronary Vessels; Exercise; Female; Humans; Middle Aged; Multidetector Computed Tomography; Pulmonary Artery; Recurrence; Reoperation; Septal Occluder Device; Stents
PubMed: 34881707
DOI: 10.5543/tkda.2021.21059 -
Thoracic Surgery Clinics Aug 2020Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further... (Review)
Review
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.
Topics: Bronchial Fistula; Bronchoscopy; Humans; Pleural Diseases; Pneumonectomy; Pneumothorax; Respiratory Tract Fistula; Risk Factors
PubMed: 32593367
DOI: 10.1016/j.thorsurg.2020.04.008 -
Advances in Respiratory Medicine 2021Actinomycosis is a rare disease caused by Actinomyces spp. The clinical and radiological picture of the disease is uncharacter-istic, which delays the diagnosis and can...
Actinomycosis is a rare disease caused by Actinomyces spp. The clinical and radiological picture of the disease is uncharacter-istic, which delays the diagnosis and can lead to complications. We present a case of pulmonary actinomycosis complicated by a chest wall fistula in a 43-year-old man with advanced tooth decay. The patient was admitted to our Department due to a chest wall fistula with bloody discharge. A few months earlier, he was treated with antibiotics for pneumonia. Since then, weakness, exertional dyspnoea, and weight loss had been observed. On admission, increased inflammatory markers were found in laboratory tests. Chest computed tomography (CT) revealed right-sided encapsulated pleural fluid collection containing gas bubbles, pleural thickening, anterior thoracic wall soft tissues thickening and subcutaneous fat stranding. CT suggested an empyema or a breast either pleural malignancy. The picture suggested a breast or pleural tumour to differentiate with an empyema. Videothoracoscopy was performed, the histological examination of the collected samples revealed granulation tissue and bacterial colony of a morphology corresponding to Actinomyces spp. Pulmonary actinomycosis was diagnosed. Antibiotic therapy according to the guidelines was initiated and dental treatment was recommended. Healing of the fistula and significant regression of lesions in the right lung were achieved. Although it is a rare disease, actinomycosis should be considered in the differential diagnosis of any chronic infiltrative lung lesions.
Topics: Adult; Fistula; Humans; Lung Diseases; Male; Thoracic Wall; Tomography, X-Ray Computed
PubMed: 34269403
DOI: 10.5603/ARM.a2021.0071 -
Journal of Radiology Case Reports Oct 2020Bronchobiliary fistula (BBF) is a rare condition that results from the communication between the bile ducts and the bronchial tree. It is characterized by the presence...
Bronchobiliary fistula (BBF) is a rare condition that results from the communication between the bile ducts and the bronchial tree. It is characterized by the presence of bile in the sputum as pathognomonic symptom, and it is often associated with suspicious pneumonia. The most common causes include infections (e.g. echinococcosis), hepatobiliary surgery, blunt torso traumas, tumors and percutaneous transhepatic procedures. Opinions about BBF treatment are still controversial as it can be treated by both conservative and surgical procedures, while pharmacological treatments are only rarely used. This case report presents a patient who had been diagnosed with chronic BBF of unknown cause, underwent several ineffective conservative procedures and was at last surgically treated.
Topics: Aged; Biliary Fistula; Bronchial Fistula; Humans; Male; Tomography, X-Ray Computed
PubMed: 33708338
DOI: 10.3941/jrcr.v14i10.3743 -
Thorax Jun 1985
Topics: Bronchopulmonary Sequestration; Esophagus; Humans; Lung; Lung Diseases; Tracheoesophageal Fistula
PubMed: 4023999
DOI: 10.1136/thx.40.6.401 -
BMJ Case Reports Jul 2021Coronary artery fistula (CAF) is an uncommon congenital heart disease. Furthermore, aortopulmonary fistula is a rare congenital heart disease of adult onset. We report...
Coronary artery fistula (CAF) is an uncommon congenital heart disease. Furthermore, aortopulmonary fistula is a rare congenital heart disease of adult onset. We report the case of a 79-year-old man who presented with chest pain. ECG-gated cardiac CT and coronary artery angiography revealed an anomalous vessel arising from the right coronary cusp and a CAF from the left coronary descending artery. These fistulas coalesced and drained into the same portion of the pulmonary artery. Haemodynamic studies revealed that the estimated systemic-to-pulmonary flow ratio was 1.18. The mean pulmonary pressure was 14 mm Hg. We decided against surgical intervention due to his advanced age and lack of heart failure symptoms. The patient did not have any worsening heart failure and chest pain on follow-up. This was a rare case of CAF coexistent and coalesced with an aortopulmonary fistula.
Topics: Adult; Aged; Arterio-Arterial Fistula; Coronary Angiography; Coronary Vessel Anomalies; Humans; Male; Pulmonary Artery
PubMed: 34301690
DOI: 10.1136/bcr-2021-244035 -
The Annals of Thoracic Surgery Nov 2022Bronchopleural fistulas (BPFs) represent a rare catastrophic complication of pulmonary resection and carry a high mortality rate. Surgical treatments of BPF are often...
Bronchopleural fistulas (BPFs) represent a rare catastrophic complication of pulmonary resection and carry a high mortality rate. Surgical treatments of BPF are often technically difficult and can be tolerated only by a limited number of patients, while less invasive endoscopic approaches show variable success rates, mainly related to the size of the fistula. In this report, we describe the successful treatment of a large BPF by means of endoscopic autologous fat implantation; we also discuss the technical details of this surgical procedure.
Topics: Humans; Pneumonectomy; Bronchial Fistula; Pleural Diseases; Endoscopy; Bronchi
PubMed: 35216996
DOI: 10.1016/j.athoracsur.2022.02.014 -
Current Opinion in Pulmonary Medicine Jul 2016The method for identification of alveolopleural fistulae (APF) by visual inspection of air bubbles in the chest drainage system has several limitations and suffers from... (Review)
Review
PURPOSE OF REVIEW
The method for identification of alveolopleural fistulae (APF) by visual inspection of air bubbles in the chest drainage system has several limitations and suffers from poor accuracy. Here we discuss the use of a novel technique of pleural gas analysis in the identification and management of APF.
RECENT FINDINGS
We found that pleural gas analysis has higher sensitivity and specificity than visual inspection in identifying APF. Additionally, we demonstrated that intrapleural gas milieu impacts lung healing and reduction of intrapleural carbon dioxide can promote resolution of APF.
SUMMARY
Pleural gas analysis is a novel technique to identify and manage APF. Integration of gas analysis in chest drainage systems would provide a more objective method for managing chest tubes and providing a favorable pleural gas environment for lung healing.
Topics: Anastomotic Leak; Carbon Dioxide; Chest Tubes; Drainage; Humans; Oxygen; Pleural Cavity; Pneumonectomy; Pulmonary Alveoli; Respiratory Function Tests; Respiratory Tract Fistula
PubMed: 27043191
DOI: 10.1097/MCP.0000000000000282 -
Folia Morphologica 2020The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation...
BACKGROUND
The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data.
MATERIALS AND METHODS
A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals.
RESULTS
Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients.
CONCLUSIONS
Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.
Topics: Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Coronary Vessel Anomalies; Fistula; Humans; Retrospective Studies
PubMed: 31802472
DOI: 10.5603/FM.a2019.0132 -
Current Cardiology Reviews 2020Coronary Artery Fistulas (CAF) are inappropriate connections between a coronary artery and a major vessel or a cardiac chamber. These fistulas may or may not present... (Review)
Review
Coronary Artery Fistulas (CAF) are inappropriate connections between a coronary artery and a major vessel or a cardiac chamber. These fistulas may or may not present with symptoms, but they need to be detected as early as possible in order to decide the most appropriate treatment methodology (i.e. surgery vs. conservative management). We report the case of a 67-year-old female with no modifiable cardiovascular risk factors who had an unwitnessed sudden death at home during her ongoing evaluation of a fistula detected incidentally between the Left Anterior Descending Artery (LAD) and the Pulmonary Artery (PA). This case highlights that early diagnosis and treatment of symptomatic CAF are crucial to minimize the risk of sudden cardiac death. Although the symptomatic fistula of LAD to PA has been reported in the literature multiple times, it has been rarely reported that this fistula can result in sudden cardiac death.
Topics: Aged; Coronary Vessel Anomalies; Death, Sudden, Cardiac; Female; Fistula; Humans
PubMed: 31593531
DOI: 10.2174/1573403X15666191008100848