Patient was treated with vancomycin, cefepime and flagyl. Bronchopleural fistula definition of bronchopleural. A pathological connection between the main stem, lobar, or segmental bronchus and the pleural space is termed bronchopleural fistula bpf. The latter includes the selfexpandable stent or classic dumon stent. Conservative management of postoperative bronchopleural fistulas. Highfrequency oscillatory ventilation in an infant with. A new way to see a bronchopleural fistula ats journals. Empyema is a collection of pus in the pleural space. Bronchopleural fistula bpf is a sinus tract between the main stem, lobar, or segmental. During this period 3150 pulmonary resections were performed for various conditions and 86 fistulas occurred, an incidence of 27per cent. Dehiscence of the bronchial stump, particularly following pneumonectomy, is one of the most serious complications in lung surgery. In this critically ill infant with necrotizing pneumonia and bronchopleural fistula, we selected a ph lower limit of 7. Although rare, bpfs represent a challenging management problem and are associated with high morbidity and mortality. Here are some important points to be to be remembered while writing about bronchopleural fistula.
Conservative management of postoperative bronchopleural. To download the pdf, click the download link below. Bronchopleural fistulas bpfs carry significant morbidity. Bronchopleural fistulas chest journal american college of chest. Bronchopleural fistula 1frank free download as powerpoint presentation. Air leaks, alveolopleural or bronchopleural fistulas, either spontaneous, iatrogenic, or postsurgical, can be difficult to treat, and if prolonged in spite of proper chest tube thoracostomy they may require surgical or chemical pleurodesis with variable success.
Then, the bronchial supply to the bronchopleural fistula was sealed using a surgical sponge and a flexible bronchoscope. Healing of bronchopleural fistula using a modified dumon. Of these, a free fascial patch graft combined with a free soft tissue flap was used to close the fistula in 6 cases. The bpf was successfully occluded without complications, and there was no stent migration or any other problem seen at the 1year followup. The appearance of a bronchopleural fistula is a wellknown and frightening complication of pulmonary surgery.
In the other 5 cases, primary fistula closure or direct coverage of the fistula with a transferred flap was performed. As a result of a previous experience involving the endoscopic treatment of fistulas 2325, we began using the atrial septal occluder device in 2009 to manage a large bpf that developed after a right upper lobectomy in a patient with tuberculosis. The major causes of bpfs include surgery, bronchiectasis, necrotizing pneumonia, abscess, cancer, tuberculosis, pulmonary infarction, penetrating trauma, and barotrauma. We present a case of postpneumonectomy bpf successfully managed with a siliconecovered bronchial occlusion stent. A bronchopleural fistula is a direct connection between the bronchus and atmosphere by way of the pleural space and tube thoracostomy. Bronchopleural fistula 1frank lung hypoxia medical. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. The diagnosis and management of tracheoesophageal and. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep enough to reach another organ or the skin. Various approaches to this problem have been tried. Oct 21, 20 a bpf is often a fatal complication of lung surgery postoperatively. A case of successful thoracoscopic bpf closure using an omental flap in a 74yearold man with emphysema who developed a bpf after right lower lobectomy for lung.
This is a most common postoperative complication of lung surgeries and also one of the recently asked questions in dnb respiratory diseases theory exams. Bronchopleural fistula the western journal of emergency. Surgical treatment of the fistula is usually impossible because of the association with empyema 3. It may also develop when large airways are in communication with the pleural space following a large pneumothorax or other loss of pleural negative pressure, especially during positive pressure mechanical ventilation.
Lung ventilation and bronchopleural fistula pdf paperity. A bronchopleural fistula bpf is a cavity that develops between the bronchial tree and the pleural space. Bronchoscopic attempts to repair it were unsuccessful. Natural history of bronchopleural fistula after pneumonectomy.
Treatment of peripheral bronchopleural fistulas with endobronchial. When a fistula develops, air may travel through this. Treatment of persistent bronchopleural fistula with a manually. It is associated with significant morbidity and mortality. Although surgery remains the cornerstone of care, no standard therapeutic. Bronchopleural fistula essentials of mechanical ventilation. Case report open access thoracoscopic surgery using omental flap for bronchopleural fistula hideki endoh1, ryohei yamamoto1, nobuhiro nishizawa1 and yukitoshi satoh2 abstract background. A bronchopleural fistula bpf can lead to empyema and death after pulmonary resection. An apf is a communication between the pulmonary parenchyma distal to a segmental bronchus and the pleural space, while a bpf is a communication between a main stem, lobar, or segmental. It is associated with high mortality, morbidity and prolonged hospital stay necessitating further thoracotomy. In the other 5 cases, primary fistula closure or direct coverage of the fistula with a. Can total bronchopleural fistulas from complete stump.
With prompt recognition and conservative treatment, its likely that the prognosis of bronchopleural fistulas will improve. Diagnosis and localisation of bpf is sometimes difficult and may require multiple imaging and bronchoscopies. This grouping is important in management of patient treatment. Initial treatment is conservative, with antibiotics and tube drainage, to allow healing of the fistula. While such fistulas are rare, they are clinically problematic as they are associated with high morbidity and mortality. A bronchopleural fistula bpf is a communication between the pleural space and the bronchial tree. The technique and the results of this method are described. Risk factor of bronchopleural fistula after general thoracic surgery. It is defined as an abnormal communication between the bronchial tree and the pleural space. Most published papers deal with endoscopic and surgical treatment. Bronchopleural fistula an overview sciencedirect topics. Bronchopleural fistula is a direct communication between the bronchial tree and the pleural cavity causing an air leak from the lung. The low incidence of tuberculosis added to the development of technical and surgical thoracic equipment has greatly decreased its incidence.
Endobronchial treatment of bronchopleural fistulas by using. Bpfs can have devastating consequences, with mortality of 25% to 71% and prolonged hospital stays involving multiple procedures for survivors. Omental flap for bronchopleural fistula post pneumonectomy. Bronchopleural fistulas are communications between the bronchial tree and the pleural space. We are reporting a case of a pregnant patient with systemic lupus erythematosus on immunosuppressive medications who developed methicillinresistant staphylococcus aureus necrotizing pneumonia complicated by bronchopleural. A bronchopleural fistula is an abnormal passageway a sinus tract that develops between the large airways in the lungs the bronchi and the space between the membranes that line the lungs the pleural cavity. Alternatively, you can also download the pdf file directly to your computer, from where it can be opened using a pdf reader. A bronchopleural fistula bpf is a serious complication after pulmonary resection and carries a high mortality rate.
The majority of patients present within 3 months postoperatively, most of whom do so within the first 12 days after surgery. Postlobectomy bronchopleural fistula is a rare complication of lung resection surgery, and proper management is essential for its successful resolution. Postpneumonectomy empyema, bronchopleural fistula, treatment. Get a printable copy pdf file of the complete article 529k, or click on a page image below to browse page by page. Scribd is the worlds largest social reading and publishing site. Ucla specialists target chronic obstructive pulmonary. Bronchopleural fistula bpf, one of the potentially fatal complications after pulmonary resection, remains a therapeutic challenge. We describe a case of late bronchopleural fistula after right extrapleural pneumonectomy for malignant mesothelioma. Bpf most commonly occur after large thoracic surgeries such as pneumonectomy but can occur for other reasons such as infection or trauma.
The occurrence of bronchopleural fistula bpf after pneumonectomy is associated with high morbidity and mortality. Treatment for bpf ranges from medical management to. We report the case of a 56yearold man treated with omental flap for bpf after pneumonectomy along with. Alternatively, you can download the file locally and open with any standalone pdf reader. If this approach fails, surgery may be necessary to attempt primary.
The pdf file you selected should load here if your web browser has a pdf reader plugin installed for example, a recent version of adobe acrobat reader. Bpf or a pulmonary fistula was present in 11 patients at the time of reconstruction. Bronchopleural fistula treated with a siliconecovered. This condition is often a serious complication of lungcancer surgery. It a serious complication often caused by lung cancer surgery. Links to pubmed are also available for selected references. While most heal spontaneously, a persistent bronchopleural fistula may seriously impair the ability to ventilate a patient secondary to loss of tidal volume through the fistula. Diagnosis and management bronchopleural fistula pralay sarkar,1 twinkle chandak,2 rakesh shah3 and arunabh talwar2 department of medicine 1, and division of pulmonary, critical care and sleep medicine 2, north shorelong island jewish health system and department of radiology 3, north shore university hospital, usa abstract. Treatment of bronchopleural fistula after pneumonectomy by. Pdf the diagnosis and management of bronchopleural fistula bpf remain a major therapeutic challenge for clinicians.
The use of a modified y dumon stent associated with glue apposition on the bronchial stump allowed us to close the fistula. Endobronchial closure of bronchopleural fistula using. We describe a technique using intramucosal injection of glue to close a bronchopleural fistula via bronchoscopy. Apleural space orchestwall infection with agasproducing organism, although rare,canresult inahydropneumothorax, ascanaccidental administration ofairinto thepleural space orchest wall. Conservative treatment of postlobectomy bronchopleural fistula. A bronchopleural fistula is a severe complication of lung cancer surgery with mortality death rates varying from 10 to 27 percent depending on the study. Diagnosis and management bronchopleural fistula medind. Bronchopleural fistula bpf is a sinus tract between the mainstem, lobar or segmental bronchus and the pleural space leading to an air leak from the lung into the pleural space. In the other 5 cases, primary fistula closure or direct coverage of the fistula. The diagnosis and management of bronchopleural fistula bpf remain a major therapeutic challenge for clinicians. This is a pdf file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of. The incidence of bpf in historical patients not subjected to bronchial stump coverage bsc was between 6 and 12% after pneumonectomy for lung cancer surgery or benign disease. Two patients with postpneumonectomy bronchopleural fistula were treated successfully by using.
There was a persistent air leak, confirming diagnosis of bronchopleural fistula. Full text full text is available as a scanned copy of the original print version. Postpneumonectomy bronchopleural fistula we read with interest the article by andreetti et al. Bronchopleural fistula bpf is a lifethreatening complication after lung cancer surgery.
Thus, in principle, the treatment of the empyema and the bronchial fistula are the same in patients in whom the cavity can be obliterated surgically. The use of gelfoam in the management of bronchopleural fistula in a patient with coexisting lung cancer and mycobacterium tuberculosis infection has been reported in 1986. A bronchopleural fistula is a connection from the bronchial tree to the pleural space. A bronchopleural fistula bpf is a fistula between the pleural space and the lung. Brochopleural fistula following lung resection is a therapeuric challenge for thoracic surgeons. Managing mechanical ventilation in patient with bronchopleural fistula with coexisting acute respiratory distress syndrome is a challenging situation for the intensivist. Reconstructive surgery for bronchopleural fistula and. The first point is the terminology used to describe air leaks, ie, the differentiation between alveolarpleural fistula apf and bronchopleural fistula bpf. Jun 23, 2006 brochopleural fistula following lung resection is a therapeuric challenge for thoracic surgeons. A minor leakage from a bpf has been reported to be successfully closed endobronchially, although thoracoplasty is usually needed. In this case we used a modified y dumon stent in an attempt to close a bronchopleural fistula which. Bronchopleural fistula after pneumonectomy adult chest. Bronchopleural fistula bpf is a well recognized and potentially fatal complication of major thoracic surgery and several strategies regarding its prevention and subsequent management have been.
Bronchopleural definition of bronchopleural by medical. The society of thoracic surgeons general thoracic surgery database major procedure data collection form version 2. In pneumothorax, the communication is peripheral, between a ruptured bleb or alveolar duct and the pleural cavity. Surgical approaches for bronchopleural fistula agnol. Postpneumonectomy bronchopleural fistula is a serious complication with high morbidity and mortality l61. It is a source of morbidity and mortality in patients, particularly those who undergo lung resection. Successful management of a fistula is combined with treatment of the associated empyema cavity. Bronchopleural fistula definition of bronchopleural fistula. We evaluated principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula bpf, focusing on openwindow thoracostomy owt.
Most barotrauma occurs in patients with trauma, acute respiratory distress syndrome ards, chronic obstructive pulmonary disease copd, asthma, and postthoracic surgery. Bronchoscopic closure of bronchopleural fistula using gelfoam. A novel approach for the treatment of postpneumonectomy. Post pneumonectomy bronchopleural fistula, a right hydropneumothorax, b fob showed a possible fistulous opening at the right bronchial stump, c methylene blue injected at the suspected site, d appearance of dye in the pleural drainage system confirmed the diagnosis. Bronchopleural definition of bronchopleural by the free. Bpf, bronchopleural fistula, icg, indocyanine green bronchopleural fistulas bpfs are the result of communication between the pleural space and one or more airways or the lung parenchyma. The diversity of incidence depends on a number of factors including malignancy or benign conditions and the extent of the resection and the resection technique used 4. Bronchopleural fistula radiology reference article. This procedure resulted in dramatic improvement as assessed by clinical and radiographic findings. The society of thoracic surgeons general thoracic surgery. The lack of a consensus suggests that no optimal therapy is available.
Ventilator management of bronchopleural fistula secondary. Dec 18, 20 bpf with fistula opening being visible on fob 16. Bronchopleural fistula article about bronchopleural fistula. Treatment of persistent bronchopleural fistula with a. Mistriaged advanced life support patients in a twotiered, suburban emergency medical services system. Bronchopleural fistula successfully treated with surgical.
Bronchopleural fistula successfully treated with surgical sp. It is a severe complication after pulmonary resection and carries a high mortality rate, ranging from 25% to 67%. Postpneumonectomy bronchopleural fistula ppbpf is a devastating complication in thoracic surgery, with reported incidences varying from 3. Diagnosis is usually made with a ct scan of the chest. Surgical approaches for bronchopleural fistula bronchopleural fistula bpf is defined as a direct communication between the bronchus and the pleural space. Bronchopleural fistula after pneumonectomy remains a challenge after lung cancer surgery. Vascular and thoracic surgery of the london hospital between 1953 and 1973 is presented. Endobronchial treatment of bronchopleural fistulas by using intrabronchial valve system.
The incidence of aspiration pneumonia declines sharply if bronchopleural fistula occurs. A bronchopleural fistula is a persistent leak from the lung into the pleural space, identified by either intermittent during inspiration or continuous chest tube air leak. Different methods have been used to solve this problem conservatively, from bronchial gluing to stent placement. Other common causes of bpf include pulmonary infection causing necrosis. In early bpf, surgical treatment is generally the preferred treatment modality. Pdf diagnosis and management bronchopleural fistula.
63 784 502 214 542 1021 457 1524 686 1210 385 535 1500 1262 1086 1108 743 205 11 1320 795 496 750 39 1360 924 1401 305 428 1255 1269 1379 1100 1178