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The Journal of Thoracic and... Sep 2013A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a...
OBJECTIVE
A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a consensus suggests that no optimal therapy is available; however, endoscopic closure of a fistula may avoid extensive and potentially risky surgery.
METHODS
Seventeen patients (15 men and 2 women) with a BPF after a pneumonectomy (n = 2) or a lobectomy (n = 15), seen between 1995 and 2010, were reviewed. Their median age was 50 years (range, 14-75 years). Underlying diseases were malignant (n = 4) and nonmalignant (n = 13).
RESULTS
The mean interval between surgery and fistula development was 20 days (range, 5-270 days). Clinical symptoms leading to a diagnosis of BPF were a persistent air leak (n = 2), a persistent air leak associated with pleural empyema (n = 3), pleural empyema alone (n = 11), and dyspnea (n = 1). Mean fistula size was 3.3 mm (range, 2-9 mm). Treatment consisted of oriented pleural drainage, adequate antibiotic therapy, and endoscopic closure of the fistula with local application of silver nitrate through a flexible bronchoscope (3-15 sessions, 3 times per week). Fistula closure was successful in 16 patients, but failed in 1 patient, who died from acute respiratory distress.
CONCLUSIONS
BPF is a severe complication in thoracic surgery. The combination of pleural drainage, adequate antibiotic treatment, and mucosal application of silver nitrate, through a flexible bronchoscope, is an efficient alternative and avoids extensive surgical intervention.
Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bronchial Fistula; Bronchoscopy; Combined Modality Therapy; Drainage; Female; Humans; Male; Middle Aged; Pleural Diseases; Pneumonectomy; Respiratory Tract Fistula; Retrospective Studies; Silver Nitrate; Treatment Outcome; Young Adult
PubMed: 23810114
DOI: 10.1016/j.jtcvs.2013.04.023 -
Multimedia Manual of Cardiothoracic... Jan 2023We describe the surgical management of adult symptomatic coronary artery fistulae. The technique is a fundamental approach entailing cardiopulmonary bypass and cardiac...
We describe the surgical management of adult symptomatic coronary artery fistulae. The technique is a fundamental approach entailing cardiopulmonary bypass and cardiac arrest with the goal of fully identifying the epicardial course of the coronary fistulae as well as that of the intrapulmonary artery ostial shunt. The more accurate the localization of these primary components of the fistulous tract, the more precise and successful is the ligation of the aberrant coronary connections. This result subsequently enhances the successful surgical obliteration of the symptomatic left-to-right shunt inherent in these congenital coronary fistulae that may not manifest symptoms until adulthood. With conventional cardiopulmonary bypass, myocardial protection and arrest, the main pulmonary artery is opened between the pulmonary valve and its bifurcation. Additional antegrade cardioplegia is administered, and the ostial connection of the coronary fistulae can be identified in the wall of the main pulmonary artery and internally ligated. After this, the epicardial course of the coronary fistulae can be identified and doubly ligated as close as possible to the native coronary from which they originate as well as their approximate external connection to the main pulmonary artery.
Topics: Humans; Adult; Coronary Vessel Anomalies; Fistula; Coronary Artery Disease; Pulmonary Artery
PubMed: 36718720
DOI: 10.1510/mmcts.2022.050 -
Pediatric Cardiology 2002A case report of a patient with a large pulmonary arteriovenous fistula and valvar pulmonary stenosis is presented. The fistula was diagnosed prenatally and its effect... (Review)
Review
A case report of a patient with a large pulmonary arteriovenous fistula and valvar pulmonary stenosis is presented. The fistula was diagnosed prenatally and its effect on in utero cardiovascular growth and development documented. Due to concerns about massive intrapulmonary shunting potentially causing profound cyanosis after delivery, an EXIT (EX-utero Intrapartum Treatment) procedure was used to transfer the infant from placental to extracorporeal membrane oxygenation (ECMO) support. Severe pulmonary microvascular disease resulted in prohibitive pulmonary hypertension despite surgical ligation of the fistula. Prenatal and postnatal hemodynamic assessments of the fistula are presented and are compared to the pathologic findings.
Topics: Arteriovenous Fistula; Echocardiography; Female; Fetus; Humans; Lung; Pregnancy; Pulmonary Veins; Vascular Neoplasms
PubMed: 12170365
DOI: 10.1007/s00246-002-0127-2 -
Canadian Medical Association Journal Feb 1966A case of multiple pulmonary arteriovenous fistulas is reported. Hereditary hemorrhagic telangiectasia is a characteristic associated finding, and in this instance...
A case of multiple pulmonary arteriovenous fistulas is reported. Hereditary hemorrhagic telangiectasia is a characteristic associated finding, and in this instance affected 10 members of the patient's family over four generations. This association suggests that the pulmonary condition in its congenital form is part of a generalized vascular dysplasia. Clinically, the patient experienced increased dyspnea and fatigue but cyanosis and polycythemia were not noted. After surgical excision of the fistula with conservation of as much pulmonary tissue as possible, prompt relief of symptoms was obtained. Furthermore, angiographic studies revealed that the small fistulas in the other lung did not enlarge. The presence of multiple fistulas is not a contraindication to surgery, and such fistulas should be excised to improve the patient's condition and prevent further complications.
Topics: Adult; Angiography; Angiomatosis; Arteriovenous Fistula; Female; Humans; Pulmonary Artery; Pulmonary Veins
PubMed: 5903711
DOI: No ID Found -
Cirugia Pediatrica : Organo Oficial de... Jul 2021Congenital bronchobiliary fistula is an extremely rare malformation with high morbidity and mortality rates. Up to 2016, 36 cases had been reported worldwide.
INTRODUCTION
Congenital bronchobiliary fistula is an extremely rare malformation with high morbidity and mortality rates. Up to 2016, 36 cases had been reported worldwide.
CLINICAL CASE
11-year-old male patient with history of chronic lung disease and respiratory insufficiency, bile ptyalism and 66-80% arterial saturation, jaundice, asymmetric thorax, finger clubbing, and disseminated crackling rales. He was diagnosed through fibrobronchoscopy and CT-scan. After fistula closure and right pneumonectomy, recurrence occurred due to bile duct hypoplasia as evidenced by endoscopic retrograde cholangiopancreatography. Left lateral hepatic segmentectomy and fistula closure from the abdomen were carried out. Bronchopleural fistula persisted following intensive nutritional and antibiotic treatment. It was surgically closed using a bovine pericardial patch. Six months later, the patient had no symptoms.
DISCUSSION
Given how extremely rare this malformation is, cross-disciplinary treatment and a high grade of suspicion are needed. The presence of bile duct hypoplasia is to be considered, since it requires a thoracoabdominal approach.
Topics: Animals; Biliary Fistula; Bronchial Fistula; Cattle; Child; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Humans; Liver; Male
PubMed: 34254750
DOI: No ID Found -
Indian Journal of Cancer Dec 2015Bronchopleural fistula (BPF) complicating lung tumor ablation is rare but severe. The purpose of this article was to study its characteristics and treatments. (Review)
Review
BACKGROUND
Bronchopleural fistula (BPF) complicating lung tumor ablation is rare but severe. The purpose of this article was to study its characteristics and treatments.
MATERIALS AND METHODS
Two of 682 (0.3%) sessions of lung microwave ablation (MWA) were complicated with BPF and documented. Two electronic databases were searched for reported cases of BPF after lung tumor ablation. Case selection and data collection were done by 3 independent reviewers.
RESULTS
A 56-year-old man and a 61-year-old woman developed BPF after MWA and died. Thirteen cases (mean age 63.8, 61.5% male) of BPF with adequate information were identified from 8 articles. Of the 13 cases, 5 (38.5%) had pulmonary co-morbidity, 3 (23.1%) had a history of pulmonary surgery, 7 (53.8%) had a target tumor adjacent or abutting pulmonary pleura, and 6 (46.2%) developed severe infections. After chest tube placement, pleurodesis, endoscopic therapy, surgery, and other treatments, 12 were cured and 1 died of BPF and pneumonia.
CONCLUSION
BPF is a rare but severe complication of lung ablation, and the management needs a multidisciplinary and individualized treatment strategy.
Topics: Bronchial Fistula; Catheter Ablation; Female; Humans; Lung Neoplasms; Male; Middle Aged; Pleural Diseases; Pneumothorax; Prognosis
PubMed: 26728673
DOI: 10.4103/0019-509X.172512 -
British Heart Journal Jan 1954
Topics: Arteriovenous Fistula; Humans; Lung
PubMed: 13126356
DOI: 10.1136/hrt.16.1.34 -
Romanian Journal of Morphology and... 2021
Topics: Bronchial Fistula; Esophageal Fistula; Humans; Neoplasms
PubMed: 35673829
DOI: 10.47162/RJME.62.4.22 -
Journal of Investigative Medicine High... 2023Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between...
Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient's condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy.
Topics: Humans; Young Adult; Bronchial Fistula; Lung; Pleural Diseases; Pneumonectomy; Tuberculosis; Female; Antitubercular Agents
PubMed: 38130119
DOI: 10.1177/23247096231220466 -
Therapeutic Advances in Respiratory... 2021Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated...
Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated with high morbidity, impaired quality of life, and an increased risk of death. Incidence of BPF following pneumonectomy ranges between 4.4% and 20% with mortality ranging from 27.2% to 71%. Following lobectomy, incidence ranges from 0.5% to 1.5% in reported series. BPFs are more likely to occur following right-sided pneumonectomy, while patients undergoing bi-lobectomy were more likely to suffer BPF than those undergoing single lobectomy. In addition to supportive care, including appropriate antibiotics and nutrition, management of BPF includes pleural decontamination, BPF closure, and ultimately obliteration of the pleural space. There are surgical and bronchoscopic approaches for the management of BPF. Surgical interventions are best suited for large BPFs, and those occurring in the early postoperative period. Bronchoscopic techniques may be used for smaller BPFs, or when an individual patient is no longer a surgical candidate. Published reports have described the use of polyethylene glycol, fibrin glues, autologous blood products, gel foam, silver nitrate, and stenting among other techniques. The Amplatzer device, used to close atrial septal defects has shown promise as a bronchoscopic therapy. Following their approval under the humanitarian device exemption program for treatment of prolonged air leaks, endobronchial valves have been used for BPF. No bronchoscopic technique is universally applicable, and treatment should be individualized. In this report, we describe two separate cases where we use an Olympus 21-gauge EBUS-TBNA (endobronchial ultrasound-transbronchial needle aspiration) needle for directed submucosal injection of ethanol leading to closure of the BPF and subsequent successful resolution of PAL.
Topics: Bronchial Fistula; Ethanol; Humans; Pleural Diseases; Pneumonectomy
PubMed: 34494916
DOI: 10.1177/17534666211044411