Post-operative left bronchopleural fistula

Case contributed by Dr Maxime St-Amant

Presentation

Lung cancer.

Pre-operative chest X-ray

Modality: X-ray

A lung mass is seen involving the left upper lobe, which is compatible with primary lung cancer. Chest CT-scan was recommended.

After investigations were completed, the diagnosis was T2N0M0 primary left upper lobe cancer. The patient underwent left upper lobe pneumonectomy.

One week post-operative

Modality: X-ray

Post-op chest X-ray in this patient post left upper lobe pneumonectomy shows extensive atelectasis with ipsilateral tracheal deviation, as well as ipsilateral pleural effusion. Radiolucencies are seen in subcutaneous axillary tissue, which are normal findings in this post-op patient.

The patient was sent at home one week after one week post-operative x-ray. The patient came back 1 month later with severe chest pain and SOB.

Modality: X-ray

The X-ray was done immediately after his arrival in the ER.

The left atelectasis/pleural effusion is replaced with an extensive pneumothorax involving the entire white lung, which extends through a left costal defect. The mediastinum is in a normal position. The posterior sixth rib is transversely fractured and inferiorly displaced.

The findings are highly suspicious of a bronchopleural fistula in this postoperative patient.

Case Discussion

The patient underwent surgery, which confirmed a BPF from a bronchial stump, which was wrapped. The patient has recovered well in the next week. BPF is an important complication of pneumonectomy which must readily be recognized by the radiologist.

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Case Information

rID: 20720
Case created: 8th Dec 2012
Last edited: 19th Nov 2015
System: Chest
Inclusion in quiz mode: Included

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