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Benign emptying of the postpneumonectomy space.

Kara HV, Mallipeddi MK, Javidfar J, Onaitis MW - Lung India (2015 Nov-Dec)

Bottom Line: A drop in the air-fluid level in the postpneumonectomy space on a chest radiogram is an early sign of bronchopleural fistula (BPF).Any suspicion of BPF points to the need for urgent evaluation and appropriate management.We share our successful conservative management in a case of postpneumonectomy space emptying with a suspicion of BPF.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.

ABSTRACT
A drop in the air-fluid level in the postpneumonectomy space on a chest radiogram is an early sign of bronchopleural fistula (BPF). Any suspicion of BPF points to the need for urgent evaluation and appropriate management. Very rarely may this drop occur without the existence of a fistula, but such a condition is defined as benign emptying of the postpneumonectomy space. We share our successful conservative management in a case of postpneumonectomy space emptying with a suspicion of BPF.

No MeSH data available.


Related in: MedlinePlus

Chest x-ray of the patient (a) After chest tube placement to drain the left pneumonectomy cavity (b) Refilled left postpneumonectomy space after pulling up the chest tube
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Figure 2: Chest x-ray of the patient (a) After chest tube placement to drain the left pneumonectomy cavity (b) Refilled left postpneumonectomy space after pulling up the chest tube

Mentions: She was discharged on the fifth postoperative day uneventfully. Her chest radiogram showed that her left pleural cavity was almost filled with fluid [Figure 1a]. Six weeks after discharge she presented for routine follow-up. She did not have any serious symptoms, only some pain on the site of the thoracotomy incision. She was afebrile, with benign physical exam findings and with normal lung sounds on the right side. Her white blood cell count was normal. Her chest radiogram showed a marked increase in air (a drop in the air-fluid level compared to the previous chest radiogram) in the left hemithorax, which was a concerning suggesting an interval development of a BPF causing emptying of the space [Figure 1b]. Although there were no obvious signs of infection related to a possible BPF, we hospitalized the patient and placed a chest tube to drain the left hemithorax [Figure 2a]. The fluid samples taken from the left pleural space did not show any signs of bacterial contamination. With an excess of caution we performed fiberoptic bronchoscopy under general anesthesia. Even under positive pressure ventilation, this too did not yield any signs or findings of BPF.


Benign emptying of the postpneumonectomy space.

Kara HV, Mallipeddi MK, Javidfar J, Onaitis MW - Lung India (2015 Nov-Dec)

Chest x-ray of the patient (a) After chest tube placement to drain the left pneumonectomy cavity (b) Refilled left postpneumonectomy space after pulling up the chest tube
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663868&req=5

Figure 2: Chest x-ray of the patient (a) After chest tube placement to drain the left pneumonectomy cavity (b) Refilled left postpneumonectomy space after pulling up the chest tube
Mentions: She was discharged on the fifth postoperative day uneventfully. Her chest radiogram showed that her left pleural cavity was almost filled with fluid [Figure 1a]. Six weeks after discharge she presented for routine follow-up. She did not have any serious symptoms, only some pain on the site of the thoracotomy incision. She was afebrile, with benign physical exam findings and with normal lung sounds on the right side. Her white blood cell count was normal. Her chest radiogram showed a marked increase in air (a drop in the air-fluid level compared to the previous chest radiogram) in the left hemithorax, which was a concerning suggesting an interval development of a BPF causing emptying of the space [Figure 1b]. Although there were no obvious signs of infection related to a possible BPF, we hospitalized the patient and placed a chest tube to drain the left hemithorax [Figure 2a]. The fluid samples taken from the left pleural space did not show any signs of bacterial contamination. With an excess of caution we performed fiberoptic bronchoscopy under general anesthesia. Even under positive pressure ventilation, this too did not yield any signs or findings of BPF.

Bottom Line: A drop in the air-fluid level in the postpneumonectomy space on a chest radiogram is an early sign of bronchopleural fistula (BPF).Any suspicion of BPF points to the need for urgent evaluation and appropriate management.We share our successful conservative management in a case of postpneumonectomy space emptying with a suspicion of BPF.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.

ABSTRACT
A drop in the air-fluid level in the postpneumonectomy space on a chest radiogram is an early sign of bronchopleural fistula (BPF). Any suspicion of BPF points to the need for urgent evaluation and appropriate management. Very rarely may this drop occur without the existence of a fistula, but such a condition is defined as benign emptying of the postpneumonectomy space. We share our successful conservative management in a case of postpneumonectomy space emptying with a suspicion of BPF.

No MeSH data available.


Related in: MedlinePlus