대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1142 Date 2019-09-17

  • Courtesy of Eun Young Kim, Hee Young Lee / Gachon University Gil Medical Center
  • Age/Sex 77 / M
  • Chief ComplaintDyspnea (2 weeks after VATS RLLobectomy for NSCLC)
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Bronchopleural fistula
Radiologic Findings
Fig 1. Chest PA shows pneumothorax in right hemithorax
Fig 2. Postcontrast CT shows large amount of hydropneumothorax in right hemithorax and mild passive atelectasis in the adjacent right lung
Fig 3. Precontrast chest CT shows bronchopleural fistula in right hemithorax
Brief Review

Defined as communication between the pleural space and the bronchial tree.

Causes
• Postoperative complication of pulmonary resection: m/c
• Lung necrosis complicating infection
• Persistent spontaneous pneumothorax
• Chemotherapy or radiotherapy (for lung cancer)
• Tuberculosis

BPF is a potentially life-threatening complication with an incidence of 0-9% and associated mortality of 16-23%. During the immediate postoperative period, the main cause of BPF is failure to obliterate the bronchial stump, whereas delayed BPF is usually due to infection or tumor recurrence at the stump. Half of all BPF occurs early, within the 1st postoperative week.

Imaging features
1) Chest radiography
• Failure of the post-pneumonectomy space to fill with fluid
• Persistent or progressive ipsilateral pneumothorax• ≥ 2.0 cm drop in the air-fluid level (a decrease < 1.5 cm can be ignored unless associated with contralateral mediastinal shift).
• Persistent or progressive pneumomediastinum or subcutaneous emphysema; reappearance of air in a previously opaque pneumonectomy space.
2) CT can also demonstrate an actual fistulous communication.

Treatment:
• use an adequate drainage system and antibiotics.
• bronchoscopic repair or surgery

References
1. EJ Chae, JB Seo, SY Kim, et el. Radiographic and CT Findings of Thoracic Complications after Pneumonectomy. RadioGraphics 2006; 26:1449 –1467
Keywords
bronchus, pleura, fstula,

No. of Applicants : 61

▶ Correct Answer : 49/61,  80.3%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Other , Korea (South) JUWON KIM
  • - , Japan YUMI MAEHARA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The Jikei university , Japan TAKU GOMI
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - St. Lukes International Hospital , Japan DAISUKE YAMADA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - McGill , Canada ADRIANA SOFIA MORALES
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - McGill University Health Center , Canada Alexandre Semionov
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Japan NAOMI YUASA
  • - , India SUSHMITHA JAKKA
  • - Chungnam National University Hospital , Korea (South) JONG EUN LEE
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Other , Korea (South) INSOO JANG
  • - , Korea (South) JANG SEONG WON
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - , Korea (South) HYEWON CHOI
  • - , Korea (South) HYEYOUNG CHOI
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - , Japan SOTA MASUOKA
  • - Other , Korea (South) SEONGSU KANG
  • - Private sector , Greece VASILIOS TZILAS
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - IRSA LA ROCHEELLE , France JEAN LUC BIGOT
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
▶ Correct Answer as Differential Diagnosis : 1/61,  1.6%
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
▶ Semi-Correct Answer : 6/61,  9.8%
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - , Korea (South) JIN YOUNG LEE
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
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