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Spine
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Clinical questions…What is a bronchopleural fistula and the anaesthetic management?What are the analgesic options in corrective BPF surgery?
Pulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Charles S. Dela Cruz, Barbara Seaworth, Graham Bothamley
Most bronchopleural fistulae occur after surgery (see Chapter 17). Anatomical delineation by CT scanning is essential before making the diagnosis of a spontaneous bronchopleural fistula as large cavities with fluid levels can give the same radiographic appearance, but attempts to drain such a cavity will cause an iatrogenic bronchopleural fistula.78 Surgical management (Chapter 17) of persistent bronchopleural fistulae, despite intercostal drainage and antibiotic treatment, has improved greatly since the times of thoracoplasty, omental flaps and muscle flaps. Glues, coils and sealants via endoscopic procedures are effective and have much less post-operative morbidity.79
The thorax
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Bronchopleural fistula. This is a serious complication. Following pneumonectomy the space left behind is initially filled with air. This is slowly reabsorbed and the space fills with tissue fluid. The fluid level rises until the air is finally reabsorbed. Dehiscence of the bronchial stump leads to the development of a bronchopleural fistula and the fluid in the space (which is almost inevitably infected) is expectorated in large quantities. This complication has a high morbidity and mortality rate. The patient is nursed sitting up and turned so that the affected space is dependent, to prevent infected fluid from entering the remaining lung while arrangements are made to site a pleural drain. This should be connected to an underwater seal but not suction. Bronchopleural fistulas are unlikely to resolve spontaneously and management is highly specialised.
Post-COVID-19 pneumonia pneumatoceles: a case report
Published in European Clinical Respiratory Journal, 2022
Wasim Jamal, Muhammad Sharif, Asma Sayeed, Saad Ur Rehman, Abdulqadir J. Nashwan
A pneumatocele rupture can cause complications, including pneumothorax or pneumomediastinum. Hence it is crucial to identify cystic changes on the CT chest. This would assist physicians in risk stratifying COVID-19 patients for these complications. As almost all cases of pneumatoceles resolve spontaneously, they are treated conservatively. Percutaneous catheter drainage or surgical intervention is considered in case of tension pneumatocele and cardiovascular compromise. Infected pneumatocele may also require consultation with thoracic surgeons. However, it has been debated to consider inserting percutaneous drain for management of pneumatocele in COVID-19 pneumonia cases with a high likelihood of clinical deterioration [15]. Pneumatocele rupture resulting in a pneumothorax in severe COVID-19 patients, especially those on positive pressure ventilation, can cause life-threatening clinical deterioration. Brahmbhatt et al reported treatment of a case of pneumatocele in COVID-19 patient on high flow nasal cannula with insertion of a pigtail catheter [16]. Although there seems to be a benefit of this approach in carefully selected patients, this can cause complications, including the development of bronchopleural fistula, and hence should be carefully advocated balancing risks and benefits. It also points to a need for standardized guidelines for managing pneumatoceles in COVID-19 cases, especially those requiring intubation and mechanical ventilation.
Spontaneous pneumothorax secondary to chronic cavitary pulmonary histoplasmosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Chronic cavitary pulmonary histoplasmosis is an indolent form of Histoplasma infection. All patients with this form of disease have previously been exposed to and inoculated with Histoplasma, whether or not they developed an acute pulmonary syndrome. Almost all patients with this syndrome have chronic obstructive pulmonary disease, particularly emphysema, and tend to be elderly [3]. On biopsy, inflammation is typically seen adjacent to emphysematous bullae. The bullae become thickened and necrotic, eventually leading to fibrosis and the formation of cavitary lesions. These are most commonly seen in the apical and posterior segments of the lungs. The cavities may enlarge over time, and in some cases may lead to development of a bronchopleural fistula, as in our patient. In addition to respiratory complaints, other symptoms may include fever, weight loss, and night sweats. Treatment is prolonged and involves anti-fungal therapy, typically oral itraconazole. Amphotericin B may also be used, although its side-effect profile is significantly less favorable.
Extrapleural pneumonectomies for pleural mesothelioma
Published in Expert Review of Respiratory Medicine, 2020
Eleonora Faccioli, Alice Bellini, Marco Mammana, Nicola Monaci, Marco Schiavon, Federico Rea
Twenty studies reported data on the main complications occurring after EPP; the most relevant ones are represented in Table 2. In total, 1064 patients (24.2%) experienced at least one of these complications. The most frequent complication in every study was arrhythmias (atrial/ventricular/both), which occurred in 561 patients (52,7%), ranging from 8,4% [27] to 49% [24]. Bronchopleural fistula was reported in 86 patients (8%), ranging from 1% [47] to 12% [51]. Hemothorax and empyema occurred in 124 patients (11.6%) (from 1% [44] to 20.6% [38]) and in 139 patients (13%) (from 1.5% [38] to 29.7% [51]), respectively. Patch dehiscence (pericardial and diaphragmatic) was reported in 64 patients (6%) ranging from 0.2% [44] to 8.2% [45,50]