1
|
Maitre T, Camuset J, Faure M, Cracco C, Maalouf G, Allenbach Y, Barral M, Fekkar A, Giol M, Parrot A, Cadranel J. Enhancing antifungal treatment for chronic cavitary pulmonary aspergillosis through the addition of endobronchial valve therapy. Respir Med Case Rep 2024; 52:102106. [PMID: 39364341 PMCID: PMC11447398 DOI: 10.1016/j.rmcr.2024.102106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/06/2024] [Accepted: 08/09/2024] [Indexed: 10/05/2024] Open
Abstract
A 62-year-old male experienced anti-MDA5 dermatomyositis with lung involvement, treated with immunosuppressive therapy leading to chronic cavitary pulmonary aspergillosis in left upper lobe. Patient's history was complicated by complete left pneumothorax due to alveolar-pleural fistula occurring because of the rupture of the pulmonary cavitation. Left lung failed to re-expand despite a four-week period of pleural drainage. In addition to antifungal therapy, patient received endobronchial valve therapy in the anterior segmental bronchus of the left upper lobe leading to air leak cessation, left lung re expansion and aspergillosis cavitation closure.
Collapse
Affiliation(s)
- Thomas Maitre
- Service de Pneumologie et d’Oncologie Thoracique et Centre Constitutifs Maladies Pulmonaires Rares, Hôpital Tenon, APHP Sorbonne Université, Paris, France
- Centre d’Immunologie et des Maladies Infectieuses (Cimi Paris), INSERM U1135, Sorbonne Université, Paris, France
| | - Juliette Camuset
- Service de Chirurgie Thoracique, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Morgane Faure
- APHP-6 Sorbonne Université, Site Pitié Salpêtrière, Service de Pneumologie (Département R3S), Paris, France
| | - Christophe Cracco
- APHP-6 Sorbonne Université, Site Pitié Salpêtrière, Service de Pneumologie (Département R3S), Paris, France
| | - Georgina Maalouf
- Service de Médecine Interne, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Yves Allenbach
- Service de Médecine Interne, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Matthias Barral
- Service de Radiologie, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Arnaud Fekkar
- Laboratoire de Parasitologie, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Mihaela Giol
- Service de Chirurgie Thoracique, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Antoine Parrot
- Service de Pneumologie et d’Oncologie Thoracique et Centre Constitutifs Maladies Pulmonaires Rares, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Jacques Cadranel
- Service de Pneumologie et d’Oncologie Thoracique et Centre Constitutifs Maladies Pulmonaires Rares, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| |
Collapse
|
2
|
Yang M, Derespina K, Grant C, Vicencio A, Murthy R, Kaushik S. Bronchopleural fistula management in a pediatric patient requiring extracorporeal membrane oxygenation. Perfusion 2024:2676591241268367. [PMID: 39058277 DOI: 10.1177/02676591241268367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Bronchopleural fistula (BPF) is a connection between the bronchus and pleural cavity. It is associated with high morbidity and mortality and management of BPF has not been well described in the pediatric population. We describe a 2-year-old girl who presented with fever and increased work of breathing, found to have atypical hemolytic uremic syndrome and Streptococcus necrotizing pneumonia with development of persistent air leak due to bronchopleural fistulas requiring extracorporeal membrane oxygenation (ECMO). Three endobronchial valves were placed with successful resolution of bronchopleural fistulas. She required tracheostomy for chronic respiratory failure and endobronchial valves were eventually removed. Approximately 3.5 months after discharge to acute care rehabilitation, tracheostomy was successfully decannulated. This case highlights the successful use of endobronchial valves for resolution of BPF while on ECMO as well as the importance of further studies on optimal candidates, timing and duration of intervention in addition to sequelae of endobronchial valve placement.
Collapse
Affiliation(s)
- Margaret Yang
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Kim Derespina
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Chantal Grant
- Division of Pediatric Pulmonology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Alfin Vicencio
- Division of Pediatric Pulmonology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Raghav Murthy
- Division of Pediatric Cardiac Surgery, Department of Cardiovascular Surgery, Mount Sinai Icahn School of Medicine, New York City, NY, USA
| | - Shubhi Kaushik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| |
Collapse
|
3
|
Liu J, Li C, Liu Z, Ye L, Shen Q, Hong Q, Song Y, Ye M. Inverted Placement of Endoscopic One-Way Endobronchial Valve Combined with Gelfoam in the Closure of Bronchopleural Fistula with Empyema in a Mechanically Ventilated Patient: A Case Report. Respiration 2024; 103:166-170. [PMID: 38330927 PMCID: PMC10939507 DOI: 10.1159/000535478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/05/2023] [Indexed: 02/10/2024] Open
Abstract
Bronchopleural fistula (BPF) with empyema caused by severe necrotizing pulmonary infection is a complicated clinical problem that is often associated with poor general condition so surgical interventions cannot be tolerated in most cases. Here, we present the successful management of multiple BPF with empyema in a mechanically ventilated patient with aspiration lung abscess. Occlusion utilizing Gelfoam followed by endobronchial valves (EBVs) implanted inverted via bronchoscope decreased the air leaking significantly and made intrapleural irrigation for empyema achievable and safe. This is the first report of a novel way of EBV placement and the combination use with other occlusive substances in BPF with empyema in a patient on mechanical ventilation. This method may be an option for refractory BPF cases with pleural infection.
Collapse
Affiliation(s)
- Jie Liu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,
- Shanghai Respiratory Research Institute, Shanghai, China,
| | - Chun Li
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Shanghai, China
| | - Zilong Liu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ling Ye
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinjun Shen
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qunying Hong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Shanghai, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Shanghai, China
| | - Maosong Ye
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Shanghai, China
| |
Collapse
|
4
|
Frey JW, Postigo M, Pitts LR. Endobronchial Valve Placement as Salvage Therapy in the Management of Hemoptysis. J Bronchology Interv Pulmonol 2023; 30:301-303. [PMID: 36083199 DOI: 10.1097/lbr.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- John W Frey
- Division of Pulmonary and Critical Care Medicine, University of Kansas School of Medicine, Kansas City, KS
| | | | | |
Collapse
|
5
|
Zhao P. Progress Report on Interventional Treatment for Bronchopleural Fistula. Emerg Med Int 2023; 2023:8615055. [PMID: 37398639 PMCID: PMC10310459 DOI: 10.1155/2023/8615055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives Bronchopleural fistula (BPF) is a serious and life-threatening complication. Following the advent of interventional radiology, subsequent treatment methods for BPF have gradually diversified. Therefore, this article provides an overview of the present scenario of interventional treatment and research advancements pertaining to BPF. Methods Relevant published studies on the interventional treatment of BPF were identified from the PubMed, Sci-Hub, Google Scholar, CNKI, VIP, and Wanfang databases. The included studies better reflect the current status of and progress in interventional treatments for BPF with representativeness, reliability, and timeliness. Studies with similar and repetitive conclusions were excluded. Results There are many different interventional treatments for BPF that can be applied in cases of BPF with different fistula diameters. Conclusion The application of interventional procedures for bronchopleural fistula has proven to be safe, efficacious, and minimally invasive. However, the establishment of comprehensive, standardized treatment guidelines necessitates further pertinent research to attain consensus within the medical community. The evolution of novel technologies, tools, techniques, and materials specifically tailored to the interventional management of bronchopleural fistula is anticipated to be the focal point of forthcoming investigations. These advancements present promising prospects for seamless translation into clinical practice and application, thereby potentially revolutionizing patient care in this field.
Collapse
Affiliation(s)
- Pei Zhao
- The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
| |
Collapse
|
6
|
Endobronchial Valve Placement for Pulmonary Tuberculosis-related Bronchocutaneous Fistula After Thoracoplasty. J Bronchology Interv Pulmonol 2021; 27:294-296. [PMID: 32452980 DOI: 10.1097/lbr.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Mukhtar O, Khalid M, Shrestha B, Alhafdh O, Pata R, Bakhiet M, Quist J, Enriquez D, Shostak E, Schmidt F. Endobronchial valves for persistent air leak all-cause mortality and financial impact: US trend from 2012-2016. J Community Hosp Intern Med Perspect 2019; 9:397-402. [PMID: 31723383 PMCID: PMC6830260 DOI: 10.1080/20009666.2019.1675229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Endobronchial valves (EBV) are considered an innovation in the management of the persistent air leak (PAL). They offer a minimally invasive alternative to the traditional approach of pleurodesis and surgical intervention. We examined trends in mortality, length of stay (LOS), and resources utilization in patients who underwent EBV placement for PAL in the US. Methods: We utilized discharge data from the Nationwide Inpatient Sample (NIS) for five years (2012–2016). We included adults diagnosed with a pneumothorax who underwent EBV insertion at ≥ 3 days from the day of chest tube placement; or following invasive thoracic procedure. We analyzed all-cause mortality, LOS, and resources utilization in the study population. Results: A total of 1,885 cases met our inclusion criteria. Patients were mostly middle-aged, males, whites, and had significant comorbidities. The average LOS was 21.8 ± 20.5 days, the mean time for chest tube placement was 3.8 ± 5.9 days, and the mean time for EBV insertion was 10.5 ± 10.3 days. Pleurodesis was performed before and after EBV placement and in 9% and 6%, respectively. Conclusions: Our study showed that the all-cause mortality rate fluctuated throughout the years at around 10%. Despite EBV being a minimally invasive alternative, its use has not trended up significantly during the study period. EBVs are also being used off-label in the US for spontaneous pneumothorax. This study shall provide more data to the scarce literature about EBV for PAL.
Collapse
Affiliation(s)
- Osama Mukhtar
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Mazin Khalid
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Binav Shrestha
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Oday Alhafdh
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Ramakanth Pata
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Manal Bakhiet
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Joseph Quist
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Danilo Enriquez
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Eugene Shostak
- Department of Cardiothoracic Surgery, Weill-Cornell Medicine, New York, NY, USA
| | - Frances Schmidt
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| |
Collapse
|
8
|
|
9
|
Zhang C, Pan Y, Zhang RM, Wu WB, Liu D, Zhang M. Late-onset bronchopleural fistula after lobectomy and adjuvant chemotherapy for lung cancer: A case report and review of the literature. Medicine (Baltimore) 2019; 98:e16228. [PMID: 31261579 PMCID: PMC6617183 DOI: 10.1097/md.0000000000016228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Late-onset bronchopleural fistula (BPF) induced by chemotherapy after lobectomy for lung cancer is rarely reported, lacking reliable preventive approaches. A timely identification and individualized treatment is essential for prognosis. PATIENT CONCERNS A 52-year-old female patient complained of fever, productive cough, and fatigue 1 week after adjuvant chemotherapy following right lower lobectomy and systemic mediastinal lymph node dissection. Chest computed tomography (CT) indicated pneumothorax and thick-walled empyema cavity within her right-sided thorax. DIAGNOSES The patient was diagnosed as late-onset BPF based on clinical manifestation and chest radiography. INTERVENTIONS In addition to antibiotics, a chest tube was reinserted under CT guidance, and vacuum suction was utilized for continuous drainage. Next cycle of adjuvant chemotherapy was terminated. OUTCOMES The empyema cavity was gradually closed in 1 month after conservative treatment, and the patient survived with good condition up to now. LESSONS Late-onset BPF should be kept in mind when the patient suffered from productive cough and chills during postoperative chemotherapy. And a prompt conservative management might be effective.
Collapse
Affiliation(s)
- Chu Zhang
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing
| | - Yong Pan
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou
| | - Rui-Mei Zhang
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou
| | - Wen-Bin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, China
| | - Dong Liu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, China
| |
Collapse
|
10
|
Intrabronchial valves for persistent pulmonary air leaks in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
11
|
|
12
|
Bader S, Faul C, Raab S, Schwaiblmair M, Berghaus TM. Successful long-term treatment of persistent pulmonary air leak in pneumocystis jirovecii pneumonia by unidirectional endobronchial valves. Respir Med Case Rep 2018; 25:170-173. [PMID: 30181950 PMCID: PMC6121160 DOI: 10.1016/j.rmcr.2018.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 11/01/2022] Open
Abstract
Spontaneous pneumothorax is a rare complication of pneumocystis jirovecii pneumonia. We report a patient with pneumocystis jirovecii pneumonia and therapy-refractory, right-sided pneumothorax due to persistent air leak (PAL) despite prolonged chest tube placement and multiple pleurodesis attempts. Due to the patient's morbidity, we evaluated if the PAL can be sealed by unidirectional endobronchial valves (EBVs). After occlusion of the right upper lobe by a balloon catheter, the air leak flow-rate decreased from 800 ml/min to 250 ml/min. Zephyr EBVs (ZEBVs) were placed in the segmental right upper lobe bronchi and subsequently, a complete resolution of the pneumothorax was noted. During 30 months of follow-up, neither recurrence of pneumothorax nor any adverse events of EBV treatment were noted. We conclude that ZEBV placement might be an effective and well-tolerated treatment option for PAL secondary to pneumocystis jirovecii pneumonia with promising long-term results.
Collapse
Affiliation(s)
- Stefanie Bader
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Germany
| | - Christian Faul
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Germany
| | - Stephan Raab
- Department of Thoracic Surgery, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Germany
| | - Martin Schwaiblmair
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Germany
| | - Thomas M Berghaus
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Germany
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated anesthetic care during these procedures. These patients may not be candidates for surgical treatment and often have multiple comorbidities. It is important for anesthesiologists to familiarize themselves with these procedures and their associated risks and complications. RECENT FINDINGS The scope of the interventional pulmonologist's practice is varied and includes both diagnostic and therapeutic procedures. Bronchial thermoplasty is now offered as endoscopic treatment of severe asthma. Endobronchial lung volume reduction procedures are currently undergoing clinical trials and may become more commonplace. Interventional pulmonologists are performing medical thoracoscopy for the treatment and diagnosis of pleural disorders. Interventional radiologists are performing complex pulmonary procedures, often requiring anesthesia. SUMMARY The review summarizes the procedures now commonly performed by interventional pulmonologists and interventional radiologists. It discusses the anesthetic considerations for and common complications of these procedures to prepare anesthesiologists to safely care for these patients. Investigational techniques are also described.
Collapse
|
14
|
Criss CN, Barbaro R, Bauman KA, Folafoluwa O, Vellody R, Jarboe MD. Selective Management of Multiple Bronchopleural Fistulae in a Pediatric Patient on Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach. J Laparoendosc Adv Surg Tech A 2018; 28:1271-1274. [PMID: 29920152 DOI: 10.1089/lap.2018.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This case highlights the successful utilization of a multidisciplinary approach to numerous bilateral bronchopleural fistulae (BPF) using minimally invasive techniques. In this study, we present a previously healthy 14-year-old male hospitalized with 2009 H1N1 influenza and methicillin-resistant Staphylococcus aureus coinfection complicated by severe acute respiratory distress syndrome and multifocal necrotizing pneumonia, with significant lung tissue damage requiring prolonged extracorporeal membrane oxygenation (ECMO) support. METHODS The development of multiple BPFs precluded lung recruitment necessary to wean from ECMO. Treatment options were very limited and endobronchial valves were considered. However, localizing single airleaks with a fogarty balloon is normally the technique to determine appropriate location to place the valves. With multiple fistulae, this technique would be ineffective. Therefore, the patient was brought to interventional radiology and bronchography was performed for selective fistula mapping. With this precise localization, the multiple fistulae were ultimately controlled using image-guided embolization and the placement of multiple endobronchial valves. The success of this intervention enabled positive pressure ventilator support and rehabilitation required for weaning from ECMO support. CONCLUSION This case highlights the successful utilization of a multidisciplinary approach to numerous bilateral BPFs using minimally invasive techniques.
Collapse
Affiliation(s)
- Cory N Criss
- 1 Section of Pediatric Surgery, Department of Surgery, Michigan Medicine , Ann Arbor, Michigan
| | - Ryan Barbaro
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Michigan Medicine , Ann Arbor, Michigan
| | - Kristy Ann Bauman
- 3 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Michigan Medicine , Ann Arbor, Michigan
| | - Odetola Folafoluwa
- 2 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Michigan Medicine , Ann Arbor, Michigan
| | - Ranjith Vellody
- 4 Department of Interventional Radiology, Children's National Health System , Washington, District of Columbia
| | - Marcus D Jarboe
- 1 Section of Pediatric Surgery, Department of Surgery, Michigan Medicine , Ann Arbor, Michigan
| |
Collapse
|
15
|
Yanagiya M, Matsumoto J, Nagano M, Kusakabe M, Matsumoto Y, Furukawa R, Ohara S, Usui K. Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation: A case report. Medicine (Baltimore) 2018; 97:e9921. [PMID: 29443771 PMCID: PMC5839832 DOI: 10.1097/md.0000000000009921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE The development of postoperative bronchopleural fistula (BPF) remains a challenge in thoracic surgery. We herein report a case of BPF successfully treated with endoscopic bronchial occlusion under computed tomography (CT) fluoroscopy and virtual bronchoscopic navigation (VBN). PATIENT CONCERNS A 63-year-old man underwent right upper lobectomy with concomitant S6a subsegmentectomy for lung adenocarcinoma. On postoperative day 24, he complained of shaking chills with high fever. DIAGNOSES BPF with subsequent pneumonia and empyema. INTERVENTIONS Despite aggressive surgical interventions for the BPF, air leakage persisted postoperatively. On days 26 and 34 after the final operation, endobronchial occlusions were performed under CT fluoroscopy and VBN. OUTCOMES The air leaks greatly decreased and the patient was discharged. LESSONS CT fluoroscopy and VBN can be useful techniques for endobronchial occlusion in the treatment of BPF.
Collapse
Affiliation(s)
| | - Jun Matsumoto
- Department of General Thoracic Surgery, NTT Medical Center Tokyo
| | - Masaaki Nagano
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine
| | | | - Yoko Matsumoto
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Sayaka Ohara
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| |
Collapse
|
16
|
Dheda K, Gumbo T, Maartens G, Dooley KE, McNerney R, Murray M, Furin J, Nardell EA, London L, Lessem E, Theron G, van Helden P, Niemann S, Merker M, Dowdy D, Van Rie A, Siu GKH, Pasipanodya JG, Rodrigues C, Clark TG, Sirgel FA, Esmail A, Lin HH, Atre SR, Schaaf HS, Chang KC, Lange C, Nahid P, Udwadia ZF, Horsburgh CR, Churchyard GJ, Menzies D, Hesseling AC, Nuermberger E, McIlleron H, Fennelly KP, Goemaere E, Jaramillo E, Low M, Jara CM, Padayatchi N, Warren RM. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. THE LANCET. RESPIRATORY MEDICINE 2017; 5:S2213-2600(17)30079-6. [PMID: 28344011 DOI: 10.1016/s2213-2600(17)30079-6] [Citation(s) in RCA: 382] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/24/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022]
Abstract
Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues.
Collapse
Affiliation(s)
- Keertan Dheda
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kelly E Dooley
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruth McNerney
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Megan Murray
- Department of Global Health and Social Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward A Nardell
- TH Chan School of Public Health, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Leslie London
- School of Public Health and Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Grant Theron
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Paul van Helden
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Schleswig-Holstein, Germany; German Centre for Infection Research (DZIF), Partner Site Borstel, Borstel, Schleswig-Holstein, Germany
| | - Matthias Merker
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Schleswig-Holstein, Germany
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Annelies Van Rie
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; International Health Unit, Epidemiology and Social Medicine, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Gilman K H Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Jotam G Pasipanodya
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Camilla Rodrigues
- Department of Microbiology, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frik A Sirgel
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Aliasgar Esmail
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Sachin R Atre
- Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA; Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kwok Chiu Chang
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong SAR, China
| | - Christoph Lange
- Division of Clinical Infectious Diseases, German Center for Infection Research, Research Center Borstel, Borstel, Schleswig-Holstein, Germany; International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Payam Nahid
- Division of Pulmonary and Critical Care, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Zarir F Udwadia
- Pulmonary Department, Hinduja Hospital & Research Center, Mumbai, India
| | | | - Gavin J Churchyard
- Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Advancing Treatment and Care for TB/HIV, South African Medical Research Council, Johannesburg, South Africa
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kevin P Fennelly
- Pulmonary Clinical Medicine Section, Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Eric Goemaere
- MSF South Africa, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Marcus Low
- Treatment Action Campaign, Johannesburg, South Africa
| | | | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), MRC HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Robin M Warren
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
17
|
Muruganandan S, Kumar S, Lee YCG. Blood Patch for Pneumothorax: a Literature Review. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0163-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
Levin A, Sklyuev S, Felker I, Tceymach E, Krasnov D. Endobronchial valve treatment of destructive multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2016; 20:1539-1545. [PMID: 27776598 PMCID: PMC5072385 DOI: 10.5588/ijtld.16.0033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In accordance with the existing hypothesis, the application of an endobronchial valve (EbV) leads to selective curative atelectasis of the affected part of the lung, contributing to early closure of cavities. OBJECTIVE To assess the effect of EbV treatment on the course of tuberculosis (TB). METHODS We compared the efficacy of EbV treatment and complex second-line treatment in treating patients with destructive pulmonary multidrug-resistant TB (MDR-TB). Bacteriological conversion and closure of cavities were selected as criteria to assess the effectiveness of EbV application. A total of 102 patients with destructive MDR-TB were enrolled into the study and randomly divided into two groups: 49 patients had an EbV installed (intervention group) and 53 patients received complex second-line treatment (control group). Complex chemotherapy was administered to both groups throughout the study period. RESULTS The cure rate in the short- and long-term follow-up periods in the intervention group was shown to be much higher, 95.9% by bacteriological conversion and 67.3% by cavity closure. On comparison with the control group, this was respectively 37.7% and 20.7% (P < 0.0001). CONCLUSIONS The application of EbV treatment can significantly improve the effectiveness of second-line chemotherapy regimens in MDR-TB patients.
Collapse
Affiliation(s)
- A Levin
- Clinical Department, Novosibirsk TB Research Institute, Novosibirsk, Russian Federation
| | - S Sklyuev
- Clinical Department, Novosibirsk TB Research Institute, Novosibirsk, Russian Federation
| | - I Felker
- Scientific Department, Novosibirsk TB Research Institute, Novosibirsk, Russian Federation
| | - E Tceymach
- Altai Medical State University, Operative Surgery and Topographic Anatomy Department, Barnaul, Russian Federation
| | - D Krasnov
- Scientific Department, Novosibirsk TB Research Institute, Novosibirsk, Russian Federation
| |
Collapse
|
19
|
Cameron RB. Minimally invasive closure of bronchopleural fistulae with novel closure devices: Fantasy or reality? J Thorac Cardiovasc Surg 2016; 152:e121-e122. [PMID: 27566886 DOI: 10.1016/j.jtcvs.2016.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Robert B Cameron
- Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif; Division of Thoracic Surgery, Department of Surgery and Perioperative Care, West Los Angeles VA Medical Center, Los Angeles, Calif.
| |
Collapse
|
20
|
Demystifying the persistent pneumothorax: role of imaging. Insights Imaging 2016; 7:411-29. [PMID: 27100907 PMCID: PMC4877351 DOI: 10.1007/s13244-016-0486-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/21/2016] [Accepted: 03/15/2016] [Indexed: 01/21/2023] Open
Abstract
Evaluation for pneumothorax is an important indication for obtaining chest radiographs in patients who have had trauma, recent cardiothoracic surgery or are on ventilator support. By definition, a persistent pneumothorax constitutes ongoing bubbling of air from an in situ chest drain, 48 h after its insertion. Persistent pneumothorax remains a diagnostic dilemma and identification of potentially treatable aetiologies is important. These may be chest tube related (kinks or malposition), lung parenchymal disease, bronchopleural fistula, or rarely, oesophageal-pleural fistula. Although radiographs remain the mainstay for diagnosis and follow up of pneumothorax, computed tomography (CT) is increasingly being used for problem solving. Aetiology of persistent air leak determines the optimal treatment. For some, a simple repositioning of the chest tube/drain may suffice; others may require surgery. In this pictorial review, we will briefly describe the physiology of pneumothorax, discuss imaging features of identifiable causes for persistent pneumothorax and provide a brief overview of treatment options. Specific aetiology of a persistent air leak may often not be immediately discernible, and will need to be carefully sought. Accurate interpretation of imaging studies can expedite diagnosis and facilitate prompt treatment. Key points • Persistent pneumothorax is defined as a leak persisting for more than 2 days. • Radiographs can identify chest-tube-related causes of pneumothorax. • CT is the most useful test to identify other causes. • Penetrating thoracic injury can cause fistulous communication resulting in a persistent pneumothorax. • Discontinuity of visceral pleura identified by CT may indicate a bronchopleural fistula.
Collapse
|
21
|
Use of One-Way Intrabronchial Valves in Air Leak Management After Tube Thoracostomy Drainage. Ann Thorac Surg 2016; 101:1891-6. [PMID: 26876341 DOI: 10.1016/j.athoracsur.2015.10.113] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/29/2015] [Accepted: 10/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND A persistent air leak represents significant clinical management problems, potentially affecting morbidity, mortality, and health care costs. In 2008, a unidirectional, intrabronchial valve received humanitarian device exemption for use in managing prolonged air leak after pulmonary resection. Since its introduction, numerous reports exist but no large series describe current utilization or outcomes. Our aim was to report current use of intrabronchial valves for air leaks and review outcome data associated with its utilization. METHODS A multicenter, retrospective review of intrabronchial valve utilization from January 2013 to August 2014 was performed at eight centers. Data regarding demographics, valve utilization, and outcomes were analyzed. RESULTS We identified 112 patients undergoing evaluation for intrabronchial valve placement, with 67% (75 of 112) undergoing valve implantation. Nearly three quarters of patients underwent valve placement for off-label usage (53 of 75). A total of 195 valves were placed in 75 patients (mean 2.6 per patient; range, 1 to 8) with median time to air leak resolution of 16 days (range, 2 to 156). CONCLUSIONS We present the largest, multicenter study of patients undergoing evaluation for intrabronchial valve use for air leak management. Our data suggest the majority of intrabronchial valve placements are occurring for off-label indications. Although the use of intrabronchial valves are a minimally invasive intervention for air leak management, the lack of rigorously designed studies demonstrating efficacy remains concerning. Prospective randomized controlled studies remain warranted.
Collapse
|
22
|
Ahn JY, Kim D, Hong JM, Kim SW. A recurrent empyema with peripheral bronchopleural fistulas treated by retrograde bronchial sealing with Gore Tex plugs: a case report. J Thorac Dis 2016; 7:E657-61. [PMID: 26793385 DOI: 10.3978/j.issn.2072-1439.2015.11.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Bronchopleural fistulae (BPF) are communications between the bronchial tree and the pleural spaces. This anomaly is associated with significant morbidity and mortality, and its management in some patients remains a major therapeutic challenge for clinicians. Here we report a case involving a 62-year-old man with chronic empyema associated with multiple BPF caused by severe necrotizing pneumonia with parapneumonic effusion in the left lower lobe. His BPF were treated by decortication and retrograde surgical sealing with Gore-Tex plugs that were sutured to the parenchyma and bronchus and reinforced by glue and an intercostal muscle flap. The air leakage stopped immediately after surgery and the chronic empyema resolved. His subsequent postoperative course was uneventful, and he was discharged 14 days after surgery. At the 8-month follow-up visit, stable surgical outcomes with no BPF recurrence were observed. In summary, we described a novel and easy surgical technique for the repair of intractable peripheral BPF in select patients.
Collapse
Affiliation(s)
- Jin-Young Ahn
- 1 Department of Internal Medicine, 2 Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Dohun Kim
- 1 Department of Internal Medicine, 2 Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jong-Myeon Hong
- 1 Department of Internal Medicine, 2 Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Si-Wook Kim
- 1 Department of Internal Medicine, 2 Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| |
Collapse
|
23
|
Fuso L, Varone F, Nachira D, Leli I, Salimbene I, Congedo MT, Margaritora S, Granone P. Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula. Lung 2016; 194:299-305. [DOI: 10.1007/s00408-016-9841-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/02/2016] [Indexed: 11/30/2022]
|
24
|
Lopera JE. The Amplatzer Vascular Plug: Review of Evolution and Current Applications. Semin Intervent Radiol 2015; 32:356-69. [PMID: 26622098 DOI: 10.1055/s-0035-1564810] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Amplatzer Vascular Plug (AVP) was created for peripheral embolization as a modification of the family of Amplatz septal occluders used in the treatment of congenital heart malformations. The device has evolved over the years and multiple versions have been launched into the market. Each of the versions of the device has some important modifications in terms of the size of the introducer's system, number of layers, and resultant thrombogenicity. It is very important for the operator to become familiar with the unique features of the AVP, and to understand the advantages and limitations of each model in the AVP family to achieve an optimal embolic result. The purpose of this article is to review the evolution and current clinical applications of the AVP in the field of interventional radiology, with emphasis on the advantages and limitations of this device in comparison with other embolization agents.
Collapse
Affiliation(s)
- Jorge E Lopera
- Department of Radiology, UT Health Science Center at San Antonio, San Antonio, Texas
| |
Collapse
|