Free omental flap and thoracoplasty for treatment of bronchopleural fistula and Aspergillus empyema

Abstract

A 78-year-old woman was diagnosed with an abnormal shadow on a chest radiograph taken in December 2012. The patient underwent resection of the left upper lobe for lung cancer and nontuberculous mycobacteriosis, and received postoperative chemotherapy for nontuberculous mycobacteriosis. She developed pneumothorax 33 months postoperatively. Six months after an operation for pneumothorax, she presented with a bronchopleural fistula. We performed fenestration of the bronchopleural fistula and empyema, and histopathological evaluation of specimens obtained from the empyema cavity revealed Aspergillus infection. We ensured that the empyema cavity was clean for 6 months. We transposed a free omental flap to the empyema cavity, sealed the fistula with the flap, and performed thoracoplasty. The patient's postoperative clinical course was uneventful, without recurrent empyema during a follow-up period of 55 months. We consider transposition of a free omental flap and thoracoplasty as one of the effective therapeutic strategies for the management of bronchopleural fistulas and chronic empyema.