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Fan Z, Huang X, Zhang L, Huang Y, Wei L, Xing X. Successful endoscopic closure of alveolar-pleural fistula due to Aspergillus empyema using a ventricular septal defect occluder. Diagn Microbiol Infect Dis 2024; 110:116407. [PMID: 38906033 DOI: 10.1016/j.diagmicrobio.2024.116407] [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: 01/25/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
We report a patient with fever and cough for 2 months who was finally given a diagnosis of alveolar-pleural fistula due to aspergillus empyema. We successfully closed the alveolar-pleural fistula with a ventricular septal defect occluder through bronchoscopy. Endoscopic closure of an alveolar-pleural fistula with ventricular septal defect occluder is worth being explored.
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Affiliation(s)
- Zeqin Fan
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Yunnan University, Key Laboratory of Respiratory Disease Research of Department of Education of Yunnan Province, Kunming, PR China
| | - Xiaoxian Huang
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Yunnan University, Key Laboratory of Respiratory Disease Research of Department of Education of Yunnan Province, Kunming, PR China
| | - Lihui Zhang
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Yunnan University, Key Laboratory of Respiratory Disease Research of Department of Education of Yunnan Province, Kunming, PR China
| | - Yunchao Huang
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Yunnan University, Key Laboratory of Respiratory Disease Research of Department of Education of Yunnan Province, Kunming, PR China
| | - Li Wei
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Yunnan University, Key Laboratory of Respiratory Disease Research of Department of Education of Yunnan Province, Kunming, PR China
| | - Xiqian Xing
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Yunnan University, Key Laboratory of Respiratory Disease Research of Department of Education of Yunnan Province, Kunming, PR China.
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Atwi H, von Gizycki C, Ahmad S, DeCotiis C. Persistent air leak secondary to pneumothorax in COVID-19: A case report and review of literature. Respir Med Case Rep 2024; 47:101987. [PMID: 38283185 PMCID: PMC10811455 DOI: 10.1016/j.rmcr.2024.101987] [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: 04/15/2023] [Revised: 04/17/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
An air leak is a pathologic communication between an area of the endobronchial tree and the pleural space, causing continued air flow. The communication can originate from a distal portion of the airway, causing an alveolar-pleural fistula, or from a more proximal airway, causing a bronchopleural fistula. When the air leak persists beyond 5-7 days, it is classified as persistent air leak (PAL). PAL has serious implications on patient management and outcomes, such as prolonged chest tube maintenance, high rate of infections, ventilation-perfusion mismatch, and prolonged hospital stay with higher morbidity and mortality. There are currently no guidelines for the management of PAL in COVID-19 patients. We presented a case of PAL in a patient with COVID-19-associated pneumothorax successfully treated with a one-way endobronchial valve. We also reviewed current published cases of PAL secondary to COVID-19-associated pneumothorax and the various methods they were treated. The first line treatment was insertion of one or more chest tubes, but the persistence of an air leak then led to other treatment modalities. Initial early surgical evaluation followed by pleurodesis is recommended for the management of PAL. The most common surgical approaches include VATS or open thoracotomy with mechanical or chemical pleurodesis or pleurectomy. However, surgery is not always a feasible option for critically ill patients. In such cases, there are multiple less invasive options for the management of PAL, including implantable devices, such as Watanabe spigots and stents, and chemical agents, such as thermal treatments, hemostatic substances, and tissue adhesives.
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Affiliation(s)
- Hanine Atwi
- Department of Internal Medicine, Morristown Medical Center, USA
| | | | - Syed Ahmad
- Department of Internal Medicine, Morristown Medical Center, USA
| | - Christopher DeCotiis
- Department of Pulmonary and Critical Care Medicine, Morristown Medical Center, USA
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Muacevic A, Adler JR, Liu N, Nguyen DT, Phan AT, Nguyen A, Toporoff B. Bronchopulmonary Fistula Development in an Elderly Male With COVID-19 Infection. Cureus 2022; 14:e31686. [PMID: 36561584 PMCID: PMC9764027 DOI: 10.7759/cureus.31686] [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] [Accepted: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
COVID-19 pneumonia can cause a wide range of complications including pneumothorax and empyema. However, in severe cases, it can lead to bronchopulmonary fistula (BPF) formation and a persistent air leak due to a connection between the pleural space and the bronchial tree. We report the case of a 77-year-old man with a history of hypertension, who presented to the emergency department for evaluation of dyspnea. Admission labs were significant for a positive rapid antigen SARS-Cov-2 test and elevated troponin I. A chest x-ray demonstrated patchy interstitial opacification and ground glass appearance bilaterally. Within the first 24 hours of presentation, the patient developed a right-sided spontaneous pneumothorax and had a 14 French pigtail catheter placed. The patient subsequently developed a persistent air leak after chest tube placement and required video-assisted thoracoscopic surgery (VATS) with talc pleurodesis and a 32 French chest tube placement. In this unique case, we describe an elderly patient's experience of bronchopulmonary fistula formation as a complication of COVID-19 pneumonia and the successful management of this complication with VATS.
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Ma L, Yin M, Yang XL, Xu W. Risk factors for air leakage during invasive mechanical ventilation in pediatric intensive care units. Eur J Med Res 2022; 27:218. [DOI: 10.1186/s40001-022-00858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
This study aimed to investigate air leakage during invasive mechanical ventilation (IMV) in a pediatric intensive care unit (PICU) and explore potential risk factors.
Methods
We conducted a retrospective cohort study of children who underwent IMV in a single-center PICU in a tertiary referral hospital. Air leakage risk factors and factors associated with an improved outcome were assessed.
Results
A total of 548 children who underwent IMV were enrolled in this study. Air leakage occurred in 7.5% (41/548) of the cases in the PICU. Air leakage increased the duration of IMV and hospitalization time. Multivariate logistic regression analysis showed a higher risk of air leakage during IMV for PICU patients with acute respiratory dyspnea syndrome (ARDS) (OR = 4.38), a higher pediatric critical illness score (PCIS) (OR = 1.08), or a higher peak inspiratory pressure (PIP) (OR = 1.08), whereas the risk was lower for patients with central respiratory failure (OR = 0.14). The logistic model had excellent predictive power for air leakage, with an area under the curve of 0.883 and tenfold cross-validation. Patients aged between 1 and 6 years who were diagnosed with measles or pneumonia and had a low positive end-expiratory pressure (PEEP) or high PaO2/FiO2 ratio were associated with improved outcomes. Patients diagnosed with central respiratory failure or congenital heart diseases were associated with less desirable outcomes.
Conclusions
Patients with ARDS, a higher PCIS at admission or a higher PIP were at higher risk of air leakage.
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Kapoor H, Gulati V, Gulati A, Donuru A, Parekh M. Comprehensive Imaging Review of Pleural Fistulas from Diagnosis to Management. Radiographics 2022; 42:1940-1955. [PMID: 36269669 DOI: 10.1148/rg.220083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pleural fistula is an abnormal communication between the pleural cavity and an adjacent structure. The interplay of anatomic and physiologic factors including proximity to various intrathoracic structures, deep pleural recesses, and negative pleural pressures makes the pleura an easy victim of fistulization. Iatrogenic creation followed by necrotizing infections and malignancies are the most common causes. While the overall incidence and size of postsurgical pleural fistulas are decreasing with increased adoption of vascularized flaps for high-risk resections, the smaller fistulas that develop in the setting of post-radiation therapy changes, with necrotizing infections in immunosuppressed patients, and with use of newer antiangiogenic chemotherapies can be challenging to visualize directly. Imaging signs in clinical practice are often subtle and indirect. Multimodality imaging and biochemical pleural fluid analysis can offer important adjunctive information when a diagnosis is only suggested with the first imaging study. Certain pleural fistulas are inconsequential, some spontaneously close with or without diversion of flow or use of positive-pressure ventilation, while others carry a higher risk of complications or recurrence. Estimated fistula size, factors that impair healing, and the possibility of diversion are important considerations when deciding between endoscopic or surgical closure. The authors have tailored this article for a general imager or clinical practitioner and review 10 types of pleural fistulas, ranging from routine to rare, with regard to their etiology, pathophysiology, clinical cues, imaging features, nuances of pleural fluid analysis, and management options available today. ©RSNA, 2022.
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Affiliation(s)
- Harit Kapoor
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Vaibhav Gulati
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Aishwarya Gulati
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Achala Donuru
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Maansi Parekh
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
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Bugge AS, Sundset A, Aaløkken TM, Jørgensen LH. Treatment of a pneumatocele in a COVID-19 patient with endobronchial valves. BMJ Case Rep 2022; 15:15/6/e250409. [PMID: 35728911 PMCID: PMC9214299 DOI: 10.1136/bcr-2022-250409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A man in his 40s was admitted to his local hospital 6 days after the first vague symptoms of COVID-19. His general condition deteriorated, and he was treated in the intensive care unit but did not require mechanical ventilation. During his recovery, he experienced a cough spell, after which his dyspnoea recurred and rapidly increased. CT pulmonary angiogram showed a 10×18 cm cavitary lesion with an air-fluid level and surrounding atelectasis of the right lower lobe. A one-way valve mechanism had developed, leading to the formation of a pneumatocele. The patient was treated by occlusion of all bronchial segments of the right lower lobe with endobronchial valves, and the pneumatocele was evacuated with a pigtail catheter. The valves were removed 4 weeks after insertion, and the right lower lobe re-expanded. Six months after treatment, the patient had recovered completely and almost regained his former lung function.
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Affiliation(s)
| | - Arve Sundset
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Trond Mogens Aaløkken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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Umar Z, Ilyas U, Ashfaq S, Shah D, Nassar M, Trandafirescu T. Bronchopleural Fistula and Endobronchial Valve Placement in a Patient With COVID-19 Pneumonia: A Case Report With Literature Review. Cureus 2022; 14:e24202. [PMID: 35602772 PMCID: PMC9117848 DOI: 10.7759/cureus.24202] [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] [Accepted: 04/16/2022] [Indexed: 11/12/2022] Open
Abstract
Bronchopleural fistulas (BPFs) are associated with high morbidity and mortality. Though most commonly seen after surgical interventions, they are increasingly reported as complications of COVID-19 infection. We present the case of an 86-year-old man with COVID-19 pneumonia and subsequent bronchopleural fistula (BPF) with persistent air leak. Endobronchial valves were placed in apical and posterior segments of the right upper lobe resulting in successful cessation of the air leak. The purpose of the case report and literature review is to help guide the management of persistent air leak.
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Affiliation(s)
- Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Usman Ilyas
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Salman Ashfaq
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Deesha Shah
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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