Cases reported "Empyema, Pleural"

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1/37. 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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2/37. Cholelithoptysis and pleural empyema.

    We report a case of delayed cholelithoptysis and pleural empyema caused by gallstone spillage at the time of laparoscopic cholecystecomy. An occult subphrenic abscess developed, and the patient became symptomatic only after trans-diaphragmatic penetration occurred. This resulted in expectoration of bile, gallstones, and pus. Spontaneous decompression of the empyema occurred because of a peritoneo-pleuro-bronchial fistula. This is the first case of such managed nonoperatively and provides support for the importance of intraoperative retrieval of spilled gallstones at the time of laparoscopic cholecystectomy.
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3/37. Reconstruction of irradiated postpneumonectomy empyema cavity with chain-link coupled microsurgical omental and TRAM flaps.

    We present the first case of complete hemithoracic reconstruction of an irradiated postpneumonectomy recurrent empyema cavity that was unresponsive to multiple conventional treatments. The procedure described used a chain-link of two coupled free flaps consisting of an omental and TRAM flap. A single abdominal donor site and single operative position are other advantages of this technique that provides sufficient volume to obviate the need for thoracoplasty even in the largest wounds.
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keywords = operative
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4/37. Descending necrotizing mediastinitis with sternocostoclavicular osteomyelitis and partial thoracic empyema: report of a case.

    We present herein the case of a 50-year-old woman in whom descending necrotizing mediastinitis originating from an anterior neck abscess spread to the left upper bony thorax, resulting in osteomyelitis of the left sternocostoclavicular articulation and left partial thoracic empyema. Transcervical mediastinal irrigation and drainage was performed with aggressive antibiotic therapy, followed by resection of the left sternocostoclavicular joint and debridement of the anterior mediastinum. The patient had an uneventful postoperative course, and her left arm and shoulder mobility was well preserved.
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5/37. Primary intrapulmonary teratoma presenting as pyothorax.

    A female patient presented with empyema thoracis and was planned for decortication. Peroperatively a cystic mass was found in the left lower lobe which was resected and diagnosed as a case of teratoma of lung on histopathological examination. This unusual case of primary intrapulmonary teratoma is being reported here.
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6/37. Surgical management of primary lung cancer in an elderly patient with preoperative empyema.

    A 74-year-old man with primary lung cancer developed preoperative empyema but was successfully managed surgically. The patient was given a diagnosis of c-T2N1M0, stage IIB, moderately differentiated squamous cell carcinoma, but before surgery pneumothorax and empyema developed, resulting from rupture of the carcinoma. Thoracic drainage, lavage and systemic administration of antibiotics improved his empyema. As there were no malignant cells in the drainage fluid, right middle-lower bilobectomy, empyemal cavity resection and lymph node dissection were performed. The bronchial stump was covered with an intercostal muscle flap. Thoracic drainage, lavage and systemic administration of antibiotics were performed for 6 days following the operation. The patient was discharged on the 27th postoperative day without any complications having developed. The pathological diagnosis of the tumor was p-T4N2(#7)M0, stage IIIB, br(-), ly( ), v( ), p3(pleura), pm1 and d0. He died of recurrence at home 18 months after the operation. We believe the following to be the minimum requirements for surgical management of such patients: (1) immediate thoracic cavity drainage and lavage with systemic antibiotic therapy, aiming at infection control before surgery; (2) prophylactic lavage of the thoracic cavity during and after surgery and (3) coverage of the bronchial stump with an adequate flap. Six reported cases of primary lung cancer with preoperative empyema are also discussed.
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ranking = 3.5
keywords = operative
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7/37. Gastropleural fistula as complication of postpneumonectomy empyema.

    A 54-year-old woman underwent a left pneumonectomy for monolateral congenital pulmonary cysts, complicated by a pleural empyema without bronchial fistula, in the late postoperative period. The pleural empyema was evacuated and managed by means of a small thoracic drainage. Three months after discharge the patient noticed the presence of ingesta in the pleural washing fluid. Diagnostic and operative procedures in this rare case of non malignant, non traumatic gastropleural fistula are described.
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8/37. Oesophageal rupture in a patient with postoperative nausea and vomiting.

    rupture of the oesophagus (Boerhaave's syndrome) is a rare complication of forceful or suppressed vomiting. postoperative nausea and vomiting is common but does not usually lead to life-threatening complications. A case of oesophageal rupture in a man who experienced postoperative nausea and vomiting after an uncomplicated procedure is described in this report. delayed diagnosis mandated conservative treatment. The clinical presentation, diagnosis and management of oesophageal rupture is discussed.
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keywords = operative
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9/37. capnocytophaga pleural empyema following laparoscopic Nissen fundoplication. A rare complication, a rare pathogen.

    empyema complicating laparoscopic fundoplication is exceedingly rare, as is capnocytophaga infection in the immunocompetent host, with the exception of gingivitis. We report a 29-year-old healthy man who presented with capnocytophaga empyema 10 days after uneventful elective, laparoscopic Nissen fundoplication for gastroesophageal reflux disease. The exact mechanism of this complication is not known, but hypotheses, including a mini-Boerrhave's syndrome, can be drawn based on knowledge of the operation, the involvement of capnocytophaga sp., and a patient history that included severe gingivitis. Because of prompt operative evacuation of the empyema and expedient identification of capnocytophaga in the empyema fluid, appropriate antibiotic therapy was initiated. The infection was adequately treated, and the patient recovered fully. To the best of our knowledge, this is the first report of such a complication.
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keywords = operative
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10/37. An unusual intrapleural foreign body: ignored aspiration.

    A 54-year-old male patient was admitted to our department with fever, dyspnea and chest pain. Left pleural effusion and destroyed left lower lobe was noticed in his computerized chest tomography. After chest tube drainage, massive hemoptysis developed. An emergency thoracotomy was performed. A bronchopleural fistula, destroyed left lower lobe and the head of an oat were detected in the pleural space. Left lower lobectomy and perioperative pneumoperitoneum were performed. The patient had an uneventful postoperative (p.o.) course and was discharged on p.o. day 6. We present this case because of the rarity and to emphasize the clinical presentation. The physicians should be aware of life threatening complications of oat head aspiration.
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