Bronchopleural Cutaneous Fistula Research Articles

Locally advanced primary breast lymphoma: a rare case report

BackgroundPrimary Breast Lymphoma is a rare manifestation of extranodal non-Hodgkin lymphoma and accounts for less than 1% of all breast malignancies. It is defined by localized involvement of the mammary tissue by lymphomatous infiltrate in the absence of prior extramammary lymphoma and concomitant widespread disease.Case presentationA 46-year-old melanodermic woman was referred to our hospital due to an extensive ulcerated right breast lesion with signs of infection. Imaging studies revealed a large breast tumor invading the chest wall, with cortical disruption of adjacent ribs and associated pleural thickening. Later, it was complicated with a bronchopleural cutaneous fistula. Biopsy of the mass was performed and the histopathologic diagnosis was consistent with breast infiltration by diffuse large B-cell lymphoma. Concurrent widespread lymphomatous disease and preceding extramammary lymphoma were excluded. Firstly, antibiotic therapy was instituted and surgical debridement was performed in order to control the infection. Afterwards, she underwent chemotherapy and local radiotherapy, with radiologic complete response.ConclusionsThe diagnosis of primary breast lymphoma is challenging because this disease has non-specific symptoms and imaging features. Radio–pathological correlation and exclusion of systemic lymphoma are essential to establish the diagnosis and to minimize potential complications.

Bronchopleural Cutaneous Fistula

Bronchopleural Cutaneous Fistula We report the imaging findings of a 60-year-old man who presented to our institution with dyspnea and sepsis. He had undergone neoadjuvant radiation therapy and a left lobectomy 3 years previously for a non-small-cell lung carcinoma. He had been well at follow-up in another institution but recently developed worsening dyspnea. CT of the thorax was performed (Fig. 1), which revealed a bronchopleural cutaneous fistula. This is a very rare late complication of lung resection for tumors and aspergillomas [1]. Patients complain of the unusual ability of being able to breathe with their upper airway occluded, and recurrent sepsis is of significant morbidity. Treatment includes endobronchial balloon occlusion and selective endobronchial intubation [1, 2]. This case highlights the vivid clinical picture that multiplanar reconstruction with MDCT can evoke. Ailbhe O’Neill Peter Beddy St. James’s Hospital Trinity College Dublin, Ireland DOI:10.2214/AJR.07.3441 WEB—This is a Web exclusive article.

Bronchopleural cutaneous fistula due to <i>Eikenella corrodens</i>

The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens. A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks. Eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy.

Combined systemic and intrapleural treatment of Aspergillus pulmonary empyema after invasive aspergillosis

A 12-year-old immunocompromised boy was hospitalized because of invasive aspergillosis with lung and central nervous system involvement. He was treated with surgery and liposomal amphotericin B, but he developed a pulmonary empyema and a bronchopleural-cutaneous fistula. A catheter was placed through the fistula, and amphotericin B (up to 50 mg in 10 ml of 5% dextrose) was instilled daily into the pleural cavity for 45 days. Treatment was well-tolerated, and the empyema resolved completely, with no evidence of recurrence after 2 years of follow-up.

Improvement of Arterial Oxygen Saturation with Selective Lobar Bronchial Block During Hemorrhage in a Patient with Previous Contralateral Lobectomy

Improvement of Arterial Oxygen Saturation with Selective Lobar Bronchial Block During Hemorrhage in a Patient with Previous Contralateral Lobectomy

High frequency ventilation for thoracic surgery

High frequency ventilation is based on the administration of a small tidal volume at a high respiratory rate. HFV achieves adequate gas exchange by a combination of convective flow and acceleration of gas diffusion. The use of HFV through a small catheter has been shown to provide adequate gas exchange and optimal surgical conditions during laser endoscopic surgery and during resection and reconstruction of the airway. The use of one-lung and two-lung HFV during intrathoracic surgery improves gas exchange and operative conditions. HFV improves gas exchange in patients with bronchopleural-cutaneous fistula and facilitates the healing process. The future of HFV is uncertain and its clinical application is limited because of the lack of proper ventilators, monitoring devices, alarm systems, and gas humidification.

Intermittent inspiratory chest tube occlusion to limit bronchopleural cutaneous airleaks

A significant bronchopleural cutaneous fistula (BPCF) developed in a 36-year-old female who required mechanical ventilation for acute respiratory failure. Progressive increase in arterial PCO2 to 75 torr occurred because of inability to effect satisfactory alveolar ventilation. Insertion of unidirectional values into the chest tube drainage apparatus, which were closed synchronously each time the ventilator cycled to the inspiratory phase, allowed effective alveolar ventilation to be achieved with subsequent reduction of arterial CO2 to previous levels. Both high inspiratory (120 torr) and expiratory (23 torr) positive pressures were employed with intermittent mandatory ventilation (IMV). Deleterious effects on cardiopulmonary function were not observed, and the patient was weaned successfully from mechanical support with spontaneous closure of the BPCFs.

Bronchial Blockade in a Child with a Bronchopleural-Cutaneous Fistula Using A Balloon-Tipped Catheter

MUNSON, EDWIN S.; STOELTING, ROBERT K.; CANT, WILBUR F. MD*; TINKER, JOHN H. MD; TARHAN, SAIT MD Author Information

Bronchopleural Cutaneous Fistula from Infected Pacemaker Electrodes

A patient who developed a bronchopleural cutaneous fistula from long-standing infection of epicardial pacemaker electrodes is presented. Although the patient refused treatment, management of this problem is suggested, since a previously reported bronchopleural cutaneous fistula has not been reported in the English literature.

Pneumothorax in Cystic Fibrosis

Thirty-two episodes of spontaneous pneumothorax occurred with increasing frequency over a ten-year period in 15 of 400 patients with cystic fibrosis. This complication most often affected adolescents or young adults with significant lung disease. The most likely pathogenetic mechanism was rupture of a subpleural bleb. Tension pneumothorax was found frequently and accounted for most cases of severe dyspnea and cyanosis including three sudden deaths. Silent pneumothorax also occurred. Small asymptomatic pneumothoraces resolved with observation. Most pneumothoraces were treated by tube thoracostomy; rapid resolution resulted in 65%. No pleural infections occurred; two bronchopleural fistulae and one bronchopleural cutaneous fistula complicated recovery. Results of prophylaxis for recurrent pneumothorax with intrapleural installation of chemical irritants were inconclusive. No thoracotomies were performed. Pneumothorax entails vigorous pulmonary care and travel restrictions.