Bronchopleural fistula after lower lobectomy of the right lung following thoracic endovascular aortic repair

Abstract

A 77-year old male patient was admitted for the treatment of a thoracic aortic aneurysm (TAA) and primary lung cancer. A saccular aneurysm, 4.8 cm in diameter, located in the proximal segment of the descending thoracic aorta and a pulmonary tumour, 3 cm in diameter, located at the right lower lobe, with lymph node swelling, were detected simultaneously. First, a thoracic endovascular aortic repair (TEVAR) was performed for TAA, and then 45 days later, a lobectomy and radical lymph node dissection by open thoracotomy were performed safely for primary lung cancer. The postoperative course was complicated by a bronchopleural fistula (BPF). Massive necrotic changes to the bronchial stump and the intercostal muscle flap were observed during an open window thoracotomy. Both the chronic use of corticosteroids and TEVAR may have been among the predisposing factors for the occurrence of the fistula. The patient died as a result of respiratory failure 68 days after the lobectomy. This is a first case report of a BPF after a staged operation of TEVAR and major lung surgery. We reviewed and discussed the surgical strategy and timing for both the primary lung cancer and the thoracic aortic aneurysm.