Abstract
A 78-year-old woman with left pyothorax was treated with thoracic drainage and antibiotics for a month. Pyothorax and signs of inflammation remained, so she was transferred to our hospital. We diagnosed pyothorax without bronchopleural fistula and scheduled surgery. While waiting for the operation, we performed fibrinolytic therapy, after which respiratory failure developed because of expectoration. Immediate treatment resolved all symptoms, and bronchopleural fistula was diagnosed. We performed surgery using a video-assisted procedure. After removing debris from the thoracic cavity, we detected in the lung to be fistula about 1 cm in diameter. Gelatin sponges soaked in antibiotics were used to fill the fistula. No air leakage was observed after the operation, and the chest drain was removed on postoperative day 11. Subsequent progress was satisfactory. Many recent reports have described the successful treatment of bronchopleural fistula with bronchoscopic embolization of the responsible bronchus and we think this treatment should be considered first. We think our approach is suitable for bronchopleural fistula in which the responsible bronchus is unidentified in the preoperative period, as in our case.
