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Nakata JA, Arif A, Chai LF, Su S. First report of a post-pneumonectomy nocardia empyema. J Surg Case Rep 2024; 2024:rjae002. [PMID: 38304314 PMCID: PMC10832585 DOI: 10.1093/jscr/rjae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Post-pneumonectomy empyema (PPE) is an uncommon but serious complication that carries significant therapeutic challenges. We present a late-onset PPE due to Nocardia nova in an immunocompetent individual. Nine years after a right pneumonectomy for non-small cell lung cancer, surveillance scans revealed new right pleural thickening and FDG avidity concerning for recurrence. Thoracoscopic pleural biopsies were negative for malignancy, but tissue cultures grew N. nova. Nocardia empyema is rare with few reported cases. Most occur in immunocompromised hosts, and all were associated with pulmonary or disseminated nocardiosis. Our case describes the first report of a PPE secondary to Nocardia.
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Affiliation(s)
- Jonathan A Nakata
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Azzan Arif
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
| | - Louis F Chai
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Philadelphia, PA 19140, United States
| | - Stacey Su
- Division of Thoracic Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Philadelphia, PA 19140, United States
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2
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Gritsiuta AI, Bakhos CT, Abbas AE, Petrov RV. Transsternal Approach for Broncho-Pleural Fistula Closure After Right Pneumonectomy. Cureus 2023; 15:e50397. [PMID: 38213373 PMCID: PMC10783833 DOI: 10.7759/cureus.50397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Broncho-pleural fistula (BPF) is an abnormal communication between the bronchial lumen and the pleural space that typically occurs postoperatively. Surgical intervention is typically needed to patch the fistula; however, current literature lacks a gold standard for which treatment to use. With a high mortality rate, there is a clear urgency for quick and successful intervention. This case examines a 59-year-old patient presenting with a BPF 14 years after incidental pneumonectomy during upper lobectomy for invasive aspergillus. A fistula was appreciated during bronchoscopy with contrast injection. The fistula was closed via the transsternal approach through median sternotomy and pericardiotomy. This case report aims to provide a viable option to successfully repair a BPF via the transsternal approach.
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Affiliation(s)
- Andrei I Gritsiuta
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Charles T Bakhos
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, USA
| | - Abbas E Abbas
- Department of Thoracic Oncology, Warren Alpert School of Medicine at Brown University, Providence, USA
| | - Roman V Petrov
- Division of Cardiothoracic Surgery, University of Texas Medical Branch John Sealy School of Medicine, Galveston, USA
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Abbas AE. Commentary: Endoscopic device closure to fix the dam problem of postpneumonectomy bronchopleural fistula. JTCVS Tech 2020; 4:349-350. [PMID: 34318071 PMCID: PMC8306981 DOI: 10.1016/j.xjtc.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital and Fox Chase Comprehensive Cancer Center, Lewis Katz School of Medicine, Philadelphia, Pa
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Kazior MR, Streams JR, Dennis BM, King AB, Henson CP, Slinger P, McDonald S, Tong JL, Chaney MA. Pulmonary Complications After Trauma Pneumonectomy. J Cardiothorac Vasc Anesth 2020; 34:1952-1961. [PMID: 32147324 DOI: 10.1053/j.jvca.2020.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Michael R Kazior
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Jill R Streams
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Bradley M Dennis
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Adam B King
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Christopher P Henson
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Peter Slinger
- Department of Anesthesia, Toronto General Hospital, Toronto, ON, Canada
| | - Sarah McDonald
- Department of Anesthesia, Toronto General Hospital, Toronto, ON, Canada
| | - Jeffrey L Tong
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL.
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Abstract
Pleural metastasis is a common occurrence in up to 30% of patients with metastatic cancer. When lung entrapment and loculation of fluid occur, treatment is more difficult and we have named this condition "oncothorax." The malignant adhesions that entrap the lung in an oncothorax are not typically amenable to surgical decortication. The standard approach for managing these patients is to place an indwelling catheter. Other options may include pleurectomy and decortication, intrapleural hyperthermic chemoperfusion, and intrapleural photodynamic therapy. However, these procedures should be provided selectively depending on patient performance status, extent of metastatic disease, and level of experience.
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Affiliation(s)
- Roman Petrov
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Charles Bakhos
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Temple University Hospital, Fox Chase Cancer Center, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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Romagnoli R, Patrono D, Mirabella S, Strignano P, Ricchiuti A, Paraluppi G, Franchello A, Lupo F, Borasio P, Salizzoni M. Transthoracic open window hepatostomy: a salvage approach to right lobe abscesses after liver transplantation. Liver Transpl 2009; 15:818-21. [PMID: 19562719 DOI: 10.1002/lt.21717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Renato Romagnoli
- General Surgery 8 and Liver Transplantation Center, University of Turin, San Giovanni Battista Hospital, Turin, Italy
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Accelerated treatment of postpneumonectomy empyema: A binational long-term study. J Thorac Cardiovasc Surg 2008; 136:179-85. [PMID: 18603072 DOI: 10.1016/j.jtcvs.2008.01.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 12/27/2007] [Accepted: 01/29/2008] [Indexed: 01/30/2023]
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Jackson TA, Mehran RJ, Thakar D, Riedel B, Nunnally ME, Slinger P. Case 5-2007 postoperative complications after pneumonectomy: clinical conference. J Cardiothorac Vasc Anesth 2007; 21:743-51. [PMID: 17905288 DOI: 10.1053/j.jvca.2007.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Timothy A Jackson
- Department of Anesthesiology and Pain Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Baltayiannis N, Markogiannakis A, Sfyridis P, Manolis EN, Anagnostopoulos D, Bolanos N, Hatzimichalis A, Tsakris A. The Influence of Local Instillation of Fusidic Acid on the Development of Microbial Complications After Lung Resection. J Chemother 2006; 18:285-92. [PMID: 17129839 DOI: 10.1179/joc.2006.18.3.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The efficacy of local instillation of fusidic acid in the prevention of post-surgical microbial complications during various types of lung resection was studied. Four hundred ninety two consecutive patients who underwent 504 thoracotomies for non-small cell lung carcinoma during April 1998-May 2004 were reviewed. The 290 patients of the first period who underwent 298 thoracotomies received a chemoprophylactic regimen of intravenous cefuroxime while the 202 patients of the second period who underwent 206 thoracotomies were additionally treated with fusidic acid, irrigated with local instillation into the pleural space, for the prevention of postoperative septic complications. Patients were followed postoperatively for development of septic complications (empyema and bronchopleural fistula) as well as of pneumonia and wound infection. Seventeen patients (5.7%) of the first period developed empyema and 13 fistula (4.4%), whereas only 2 patients (1.0%) of the second period developed empyema and fistula (OR = 5.876; 95% CI, 1.343- 25.716; P = 0.008 and OR = 4.193; 95% CI, 1.003-20.130; P = 0.034, respectively). Cases of pneumonia decreased, but not significantly, from 21 (7.0%) during the first period to 9 (4.4%) during the second period (OR = 1.613; 95% CI, 0.724-3.593; P = 0.257) while cases of wound infection decreased significantly from 19 (6.4%) to 2 (1.0%) (OR = 6.567; 95% CI, 1.513-28.510; P = 0.003). During the first period 23 pathogens were found from cases of empyema and 73 pathogens from cases of pneumonia and wound infection, whereas during the second period 3 and 18 pathogens were respectively found (OR = 5.3; 95% CI, 1.570-17.888; P = 0.003, and OR = 2.804; 95% CI, 1.628-4.838; P <0.001, respectively). These results indicate that local instillation of fusidic acid in the pleural space prior to lung resection seems effective in reducing the rate of septic complications as well as of wound infections.
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Affiliation(s)
- N Baltayiannis
- Department of Thoracic Surgery, Metaxa Cancer Hospital, Piraeus, Greece
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