The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Successful surgery for hemorrhagic empyema accompanied by an asymptomatic bronchial fistula
Kenjiro FukuharaKatsuhiro NakagawaKiyohiro FujiwaraHiroyuki ShionoKan IdeguchiTsutomu Yasumitsu
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2002 Volume 16 Issue 4 Pages 554-558

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Abstract

We report successful surgery for chronic hemorrhagic empyema accompanied by a silent bronchial fistula detected after resection of the empyema cavity. A 68-year-old man with a history of tuberculous pleurisy was admitted because of progressive anemia, right heart insufficiency and penetration of expanding empyema cavity beyond the thoracic wall. After repetitive transcatheter embolization of the bronchial artery and internal thoracic artery, we performed curettage and resection of the empyema cavity. Then a bronchial fistula was detected at the membranous part within the right intermediate bronchus. Because of intraoperative cardiac dysfunction, we covered the bronchial fistula with intercostal muscle flap and fenestrated following omentopexy at postoperative day 13. The postoperative course was satisfactory and patient is in good health with no recurrence seven months post operatively. We speculate that the bronchial fistula was due to ischemia of the bronchial wall caused by repetitive transcatheter embolization and oppression with empyema cavity. Formerly, panpleuropneumonectomy was considered to be a radical surgical procedure for chronic hemorrhagic empyema, however, a less invasive method, curettage and resection of the empyema cavity, is also a useful technique for patients with this disease.

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