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The Journal of Thoracic and... Mar 2013Alveolar-pleural fistulas causing persistent air leaks are conditions associated with prolonged hospital courses, high morbidity, and possibly increased mortality.... (Review)
Review
OBJECTIVES
Alveolar-pleural fistulas causing persistent air leaks are conditions associated with prolonged hospital courses, high morbidity, and possibly increased mortality. Intrabronchial valves serve as a noninvasive therapeutic option for the closure of alveolar-pleural fistulas.
METHODS
The present review describes a brief history of, and indications for, the placement of intrabronchial valves in patients with persistent air leaks. The essential steps necessary for placement are air leak isolation, airway sizing, and valve deployment. Additionally, the indications and methods for intrabronchial valve removal, along with the potential complications from intrabronchial valve placement, are described.
CONCLUSIONS
The increased use of intrabronchial valves in the treatment of persistent air leaks requires bronchoscopists and clinicians to understand the procedural steps and techniques necessary for intrabronchial valve placement.
Topics: Bronchi; Bronchoscopy; Humans; Pneumothorax; Postoperative Complications; Prostheses and Implants; Prosthesis Design; Respiratory Tract Fistula; Risk Assessment
PubMed: 23312104
DOI: 10.1016/j.jtcvs.2012.12.003 -
In Vivo (Athens, Greece) 2023Rendu-Osler-Weber disease (Osler's disease) is the most common cause of pulmonary arteriovenous fistula. We report a case of pulmonary arteriovenous fistula associated...
BACKGROUND
Rendu-Osler-Weber disease (Osler's disease) is the most common cause of pulmonary arteriovenous fistula. We report a case of pulmonary arteriovenous fistula associated with Osler's disease that was treated by lobectomy.
CASE REPORT
A 44-year-old man with Osler's disease presented with respiratory distress. Computed tomography showed a pulmonary arteriovenous fistula, which had a 26-mm-long diameter in S6 of the left lung. Transcatheter treatment had a high risk of recurrence, and surgery was indicated. The pulmonary arteriovenous fistula was found at the beginning of A6. A6 and the basilar artery were cut together with a stapler. The postoperative course was uneventful, and respiratory distress symptoms improved with no recurrence.
CONCLUSION
We report a case of pulmonary arteriovenous fistula caused by Osler's disease treated by lobectomy. Although transcatheter treatment is the mainstream treatment for pulmonary arteriovenous fistulas, surgical resection may be effective depending on the size of the lesion.
Topics: Male; Humans; Adult; Telangiectasia, Hereditary Hemorrhagic; Arteriovenous Fistula; Pulmonary Veins; Dyspnea; Respiratory Distress Syndrome
PubMed: 37905648
DOI: 10.21873/invivo.13402 -
European Journal of Cardio-thoracic... Jun 1997A direct communication between the pulmonary artery and the left atrium is a rare anomaly. On the basis of two cases of our own and a literature review of 49 cases, we... (Review)
Review
OBJECTIVE
A direct communication between the pulmonary artery and the left atrium is a rare anomaly. On the basis of two cases of our own and a literature review of 49 cases, we focus on clinical presentation, anatomy, diagnosis, and the role of surgery.
METHODS
Two cases of a fistula between the right pulmonary artery and the left atrium are described in a girl of 4 years and a boy of 15 years. Both presented with unexplained cyanosis. Diagnosis was made on echocardiography and angiography. The fistula was ligated using extracorporeal circulation in the first case and not in the second case.
RESULTS
The surgical results were successful with resolution of the cyanosis.
CONCLUSIONS
In newborns, urgent surgery may be necessary. In other patients, early elective surgical correction should be performed to prevent complications, especially systemic and cerebral emboli, cerebral abscesses, and rupture of aneurysmal fistulas. Complete cure can be achieved by ligation and possible division or by intracardiac repair.
Topics: Adolescent; Child, Preschool; Coronary Angiography; Cyanosis; Echocardiography; Female; Fistula; Heart Atria; Heart Defects, Congenital; Humans; Ligation; Male; Pulmonary Artery
PubMed: 9237587
DOI: 10.1016/s1010-7940(97)01172-x -
The Clinical Respiratory Journal May 2023Acquired digestive-respiratory tract fistulas occur with abnormal communication between the respiratory tract and digestive tract caused by a variety of benign or... (Review)
Review
Acquired digestive-respiratory tract fistulas occur with abnormal communication between the respiratory tract and digestive tract caused by a variety of benign or malignant diseases, leading to the alimentary canal contents in the respiratory tract. Although various departments have been actively exploring advanced fistula closure techniques, including surgical methods and multimodal therapy, some of which have gotten good clinical effects, there are few large-scale evidence-based medical data to guide clinical diagnosis and treatment. The guidelines update the etiology, classification, pathogenesis, diagnosis, and management of acquired digestive-respiratory tract fistulas. It has been proved that the implantation of the respiratory and digestive stent is the most important and best treatment for acquired digestive-respiratory tract fistulas. The guidelines conduct an in-depth review of the current evidence and introduce in detail the selection of stents, implantation methods, postoperative management and efficacy evaluation.
Topics: Humans; Consensus; East Asian People; Respiratory System; Respiratory Tract Fistula; Stents; Treatment Outcome; Digestive System Fistula
PubMed: 37094822
DOI: 10.1111/crj.13607 -
The International Journal of... Jan 2017A 69-year-old woman was admitted to hospital 4 times from November 2007 to June 2009. The patient had silicosis complicated by broncholithiasis, esophagobronchial...
A 69-year-old woman was admitted to hospital 4 times from November 2007 to June 2009. The patient had silicosis complicated by broncholithiasis, esophagobronchial fistula, and relapsed tuberculosis. She had worked as a stone crusher for 3 years and was exposed to a large amount of quartz dust. Barium esophagography, gastroesophageal endoscopy, and biopsy suggested esophageal-related chronic inflammation and ulcer, which probably caused the repeated esophagobronchial fistulas observed. Bronchoscopy revealed a free broncholithiasis in the left main bronchus. The patient was readmitted a fourth time, for the relapse of silicotuberculosis. After 9 months of antituberculous therapy, she was doing well until the recent last follow-up visit.
Topics: Aged; Bronchial Fistula; Esophageal Fistula; Female; Humans; Lithiasis; Recurrence; Silicotuberculosis
PubMed: 28051197
DOI: 10.15171/ijoem.2017.822 -
Journal of Radiology Case Reports Sep 2023A 51-year-old female patient was presenting dyspnea for more than a year with no previous lung infections or surgery. Initially, a diagnostic computed tomography was...
A 51-year-old female patient was presenting dyspnea for more than a year with no previous lung infections or surgery. Initially, a diagnostic computed tomography was made, showing a rare arterio-arterial malformation between the right inferior phrenic and right pulmonary artery leading into a vascular bundle in the middle lung lobe. Due to the patients' dyspnea and massive extent of malformation, the indication for transcatheter arterial embolization was made. The first transcatheter arterial embolization procedure involved the inferior phrenic and a selective branch of the internal thoracic artery. Interventional angiography as well as computed tomography revealed further extend of the malformation showing a connection of right lateral thoracic, hepatic, and inferior epigastric artery to the fistula. After one month, a second transcatheter arterial embolization of these arteries as well as a second approach of the proximal internal thoracic artery was performed. In the follow-up the patient described a substantial improvement of her dyspnea and showed no signs of infections. A phrenic artery to pulmonary artery fistula is an extremely rare case occurring congenital or acquired. Patients may be asymptomatic or present, among others, dyspnea, hemoptysis, pulmonary infections and congestive heart failure. Symptomatic patients require treatment using transcatheter arterial embolization or surgical resection. The patient had dyspnea and a substantial extent of malformation with possibly complicated clinical course. The recommended less invasive treatment using transcatheter arterial embolization was successfully performed. In conclusion, our patient represented a rare congenital case of systemic and pulmonary artery communication, which we were able to treat sufficiently with coil embolization.
Topics: Female; Humans; Middle Aged; Pulmonary Artery; Lung; Angiography; Dyspnea; Fistula; Embolization, Therapeutic
PubMed: 38098960
DOI: 10.3941/jrcr.v17i8.4972 -
BMJ Case Reports Sep 2021The ideal management of bronchoesophageal fistulas is a debated topic. While open surgical repair remains the most definitive treatment, not all patients are fit for...
The ideal management of bronchoesophageal fistulas is a debated topic. While open surgical repair remains the most definitive treatment, not all patients are fit for surgery. In this communication, we present a patient who developed a bronchoesophageal fistula 1 year after an Ivor Lewis esophagectomy that involved the native oesophagus and right mainstem bronchus. Endoluminal vacuum therapy was successful at closing this benign bronchoesophageal fistula.
Topics: Bronchi; Bronchial Fistula; Esophageal Fistula; Esophagectomy; Humans
PubMed: 34544721
DOI: 10.1136/bcr-2021-245240 -
Carinal sleeve resection: last exit for bronchial insufficiency-a 17-year, single-centre experience.Interactive Cardiovascular and Thoracic... May 2021Bronchopleural fistula after pneumonectomy and dehiscence of an anastomosis after sleeve lobectomy are severe complications. Several established therapeutic options are...
OBJECTIVES
Bronchopleural fistula after pneumonectomy and dehiscence of an anastomosis after sleeve lobectomy are severe complications. Several established therapeutic options are available. Conservative treatment is recommended for a small fistula without pleural infection. In patients with a bronchopleural fistula and subsequent pleural empyema, surgical management is the mainstay. Overall, the associated morbidity and mortality are high. Carinal sleeve resection is the last resort for patients with a short stump after pneumonectomy or anastomotic dehiscence after sleeve resection near the carina.
METHODS
All patients with bronchopleural fistula after pneumonectomy or sleeve resection who underwent secondary carinal sleeve resection between 2003 and 2019 in our institution were evaluated retrospectively. Patients with anastomotic dehiscence after sleeve lobectomy underwent a completion pneumonectomy. The surgical approach was an anterolateral thoracotomy; the anastomosis was covered with muscle flap, pericardial fat or omentum majus. In case of empyema, povidone-iodine-soaked towels were introduced into the cavity and changed at least twice.
RESULTS
A total of 17 patients with an initial sleeve lobectomy in 12 patients and pneumonectomy in 5 patients were treated with carinal sleeve resection in our department. Morbidity was 64.7% and 30-day survival was 82.4% (n = 14). A total of 70.6% of the patients survived 90 days (n = 12). Median hospitalization was 17 days and the median stay in the intensive care unit was 12 days.
CONCLUSIONS
Carinal sleeve resection is a feasible option in patients with a post-pneumonectomy fistula or anastomotic insufficiency following sleeve lobectomy in the absence of alternative therapeutic strategies. Nevertheless, postoperative morbidity is high, including prolonged intensive care unit stay.
Topics: Bronchi; Bronchial Fistula; Humans; Lung Neoplasms; Pneumonectomy; Retrospective Studies
PubMed: 33772313
DOI: 10.1093/icvts/ivab031 -
Thorax Jan 1965
Topics: Bronchial Fistula; Bronchiectasis; Humans; Lung; Lung Diseases; Lung Neoplasms; Pneumonectomy; Postoperative Complications; Suture Techniques; Tuberculosis; Tuberculosis, Pulmonary
PubMed: 14255492
DOI: 10.1136/thx.20.1.8 -
The Annals of Thoracic Surgery Sep 2007
Topics: Bronchi; Bronchial Fistula; Diabetes Complications; Humans; Pleural Diseases; Pneumonectomy; Postoperative Complications; Surgical Flaps
PubMed: 17720410
DOI: 10.1016/j.athoracsur.2007.06.003