Cases reported "Bronchial Fistula"

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1/65. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case.

    We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.
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2/65. Developing bronchial fistulas as a late complication of extraperiosteal plombage.

    A 65-year-old male, who underwent extraperiosteal plombage for pulmonary tuberculosis 46 years ago, was referred to our hospital due to relapsing hemosputa and pneumonia. A chest computed tomography scan revealed a bronchial fistula and a fluid collection in one Lucite ball. On May 20, 1996, a right-anterior thoracotomy was performed in a supine position. Five Lucite balls were removed, and the empyema space was tightly filled with an omental pedicle flap. Although the bronchial fistulas were not sutured directly, the air leakage from the drainage tube ceased 12 days later. Two years postoperatively the patient has remained well. Our simple approach of combining an anterior thoracotomy and replacement of an empyema space with an omental pedicle flap in the same posture, without closing bronchial fistulas, would be an easy procedure, and therefore exploitable in patients who have a similar problem.
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keywords = empyema
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3/65. Spontaneous tension pneumopericardium complicating staphylococcal pneumonia.

    The authors describe a patient with spontaneous pneumopericardium complicating staphylococcal pneumonia and empyema that resulted in cardiac tamponade. Spontaneous pneumopericardium is an unusual disorder. The causes and clinical findings of pneumopericardium are reviewed, as are the radiographic features that differentiate this condition from pneumomediastinum. Early recognition of pneumopericardium is important, because emergent pericardiocentesis may be required if there is clinical evidence of tamponade.
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4/65. Bronchoscopic sclerotherapy combined with thoracoscopic drainage for postpneumonectomy bronchial fistula and empyema.

    A postpneumonectomy bronchial fistula is a very morbid complication that often requires major surgical procedures for treatment. Since patients with postpneumonectomy bronchial fistula and empyema are physiologically compromised, corrective surgical interventions pose considerable risk. We report a case of a postpneumonectomy fistula with an associated empyema. Our patient's empyema was treated with thoracoscopic debridement and antibiotic instillation (modification of the Clagett procedure). Bronchoscopic and thoracoscopic treatment strategies that are appropriate for selected patients with postpneumonectomy bronchial fistula and empyema are discussed.
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5/65. Conservative management of a transdiaphragmatic fistula.

    case reports of transdiaphragmatic fistulas connecting subphrenic collections and empyemas are uncommon. We report the rare complication of a fistulous connection between a subphrenic collection and the bronchial tree.
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6/65. hand-assisted laparoscopic harvesting of an omental pedicle in the treatment of complicated chronic empyema.

    We describe a new method for hand-assisted laparoscopic harvesting of an omental pedicle and its use in the treatment of chronic empyema with a bronchopulmonary fistula. This technique may also be appropriate as a less invasive surgical procedure in the treatment of a number of other thoracic infectious conditions.
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7/65. The use of a Dumon stent for the treatment of a bronchopleural fistula.

    We report the successful management of a bronchopleural fistula with bronchial stent placement combined with irrigation of the empyema cavity. A bronchopleural fistula occurred in a 67-year-old man after a right upper lobectomy for lung cancer. Resuturing of the bronchial stump plus omental wrapping and subsequent closure of the open stump with a pedicled flap of intercostal muscle were not effective. Consequently, we placed a Dumon stent in the right main bronchus to close the stump.
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keywords = empyema
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8/65. Management of postpneumonectomy bronchopleural-cutaneous fistula with a single free flap.

    A variety of local flaps have been described for chest wall and bronchopleural fistula reconstruction. When local options cannot be used because of previous surgery, trauma, radiation, or body habitus, free flaps become an acceptable option. The authors report a case of persistent bronchopleural-cutaneous fistula treated with a free latissimus dorsi musculocutaneous flap that obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleural fistula. Surgical technique including anastomosis to the innominate vein is described.
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keywords = empyema
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9/65. Transsternal transpericardial closure of a postlobectomy bronchopleural fistula.

    We report a case of chronic empyema and bronchopleural fistula after lobectomy for tuberculosis. The patient had undergone four different surgical procedures to correct his bronchopleural fistula during an interval of seven years. Finally, he had a successful closure of the fistula using the transsternal transpericardial approach.
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keywords = empyema
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10/65. Endoscopic closure of bronchopleural fistula after pneumonectomy by submucosal injection of polidocanol.

    We report two cases of a bronchopleural fistula with, and without, empyema treated by endoscopic submucosal injection of polidocanol (sclerotherapy) and application of cyanoacrylate. Case 1: A 60-year-old man underwent left pleuropneumonectomy for lung cancer. He developed bronchopleural fistula with empyema at 32 days after the operation. We performed sclerotherapy around the fistula. The air leakage stopped at 2 weeks after the sclerotherapy, and the fistula was closed. He was eventually cured of the empyema by pleural drainage. Case 2: A 61-year-old man underwent left pneumonectomy for lung cancer. He developed bronchopleural fistula without empyema at 50 days after the operation. We performed sclerotherapy and application of cyanoacrylate. After this therapy, the air leakage stopped immediately, and the bronchopleural fistula was closed. The sclerotherapy and application of cyanoacrylate are not only technically easy, but also very effective for treatment of bronchopleural fistula. sclerotherapy and cyanoacrylate may be advocated as a first therapeutic step.
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ranking = 0.4
keywords = empyema
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