Bronchial stump disruption following inadvertent right mainstem intubation 9 years after pneumonectomy

Abstract

An 82-year-old man, with a history of right pneumonectomy 9 years prior to admission, was emergently intubated for respiratory failure resulting from rapid atrial fibrillation and congestive heart failure. Postintubation chest radiograph demonstrated the tube to be in the right bronchial stump. Over the next 48 hours gas exchange remained poor, endotracheal suctioning produced copious serosanguinous secretions, and chest radio-graphs showed increasing air, with air fluid levels, in the previously opacified right hemithorax. Bronchoscopy demonstrated air bubbling from the posterior wall of the right bronchial stump, consistent with a bronchopleural fistula. The authors conclude that right mainstem intubation, in the setting of a previous right pneumonectomy, can lead to disruption of the bronchial stump with drainage of fluid from the postpneumonectomy space into the functioning left lung with severe compromise of gas exchange.