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Persistent alveolar pleural fistula

Kenneth K Sakata, Janani S Reisenauer, Ryan M Kern, John J Mullon
A persistent air leak (PAL) can be caused by either an alveolar-pleural fistula (APF) or bronchopleural fistula (BPF). Complications from PAL lead to an increase in morbidity and mortality, prolonged hospital stay, and higher resource utilization. Pulmonary physicians and thoracic surgeons are often tasked with the difficult and often times frustrating diagnosis and management of PALs. While most patients will improve with chest tube thoracostomy, many will fail requiring alternative bronchoscopic or surgical strategies...
April 2018: Respiratory Medicine
Amit K Mahajan, Sandeep J Khandhar
Unidirectional airway valves are devices used for the treatment of persistent air leaks (PALs) secondary to alveolar-pleural fistulas (APF) or bronchopleural fistulas (BPFs). These valves were originally developed as a non-surgical alternative to lung volume reduction surgery (LVRS) for patients with chronic obstructive pulmonary disease (COPD). Randomized trials investigating the use of valves for bronchoscopic LVRS did not lead to the Federal Drug Administration (FDA) approval, but stemming from these studies a Humanitarian Device Exemption (HDE) was granted to Spiration intrabronchial valves (IBVs) for the treatment of PALs...
March 2017: Journal of Thoracic Disease
Karen C Dugan, Balaji Laxmanan, Septimiu Murgu, D Kyle Hogarth
Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit it is a solution with limited success. In patients who have recently undergone thoracic surgery or in whom surgery would be contraindicated based on the severity of illness, there has been a lack of treatment options. This review describes a brief history of treatment guidelines for PALs. In the past 20 years, newer and less invasive treatment options have been developed...
August 2017: Chest
Takashi Nishihara, Manabu Hayama, Norio Okamoto, Ayako Tanaka, Takuji Nishida, Takayuki Shiroyama, Motohiro Tamiya, Naoko Morishita, Hidekazu Suzuki, Hiroto Matsuoka, Tomonori Hirashima
A prolonged air leak caused by pulmonary tuberculosis is difficult to treat, and little is known about optimal treatment strategies. We herein report the case of a 60-year-old man who demonstrated tuberculous empyema with a fistula. An air leak from a tuberculous cavity in his left upper lobe persisted for approximately 4 months; surgical repair could not be performed due to a poor physical status and undernourishment. However, the air leak was successfully treated with endobronchial occlusion using two silicone spigots in left B3b and B4, without any adverse effects or aggravation of the infection...
2016: Internal Medicine
Jae Hee Woo, Rack Kyung Chung, Hee Jung Baik, Youn Jin Kim
We present a case of an alveolar-pleural fistula with hepatic hydrothorax in a patient undergoing orthotropic liver transplantation, which was detected by drainage of transudate through an endotracheal tube during operation. A standard endotracheal tube was changed to a double-lumen tube to provide differential lung ventilation. The patient was diagnosed with an alveolar-pleural fistula by direct vision of an air leak during positive-pressure ventilation through a diaphragmatic incision. There was still a concern about worsening his ventilation due to persistent aspiration of pleural effusion towards the ipsilateral lung during the remaining operation period...
April 2015: Korean Journal of Anesthesiology
Hiren J Mehta, Paras Malhotra, Abbie Begnaud, Andrea M Penley, Michael A Jantz
BACKGROUND: Alveolar-pleural fistula with persistent air leak is a common problem causing significant morbidity, prolonged hospital stay, and increased health-care costs. When conventional therapy fails, an alternative to prolonged chest-tube drainage or surgery is needed. New bronchoscopic techniques have been developed to close the air leak by reducing the flow of air through the leak. The objective of this study was to analyze our experience with bronchoscopic application of a synthetic hydrogel for the treatment of such fistulas...
March 2015: Chest
Gregory Wiaterek, Hans Lee, Rajiv Malhotra, Wes Shepherd
Airway pleural fistulas remain a significant treatment challenge despite improved antimicrobial therapy and surgical techniques. We present a case of a 56-year-old female who was admitted with severe bilateral cavitary pneumonia requiring mechanical ventilation. The patient suffered bilateral pneumothoraces related to necrotic pneumonia resulting in bilateral chest tube placement. Despite conservative measures, the air leak persisted preventing chest tube removal. Bronchoscopy with Fogarty balloon (Edwards) occlusion was performed in attempts to isolate an airway responsible for the air leak...
April 2013: Journal of Bronchology & Interventional Pulmonology
Amit K Mahajan, Diana C Doeing, Douglas K Hogarth
OBJECTIVES: Alveolar-pleural fistulas causing persistent air leaks are conditions associated with prolonged hospital courses, high morbidity, and possibly increased mortality. Intrabronchial valves serve as a noninvasive therapeutic option for the closure of alveolar-pleural fistulas. METHODS: The present review describes a brief history of, and indications for, the placement of intrabronchial valves in patients with persistent air leaks. The essential steps necessary for placement are air leak isolation, airway sizing, and valve deployment...
March 2013: Journal of Thoracic and Cardiovascular Surgery
Christophe A Dooms, Paul R De Leyn, Jonas Yserbyt, Herbert Decaluwe, Vincent Ninane
An alveolar-pleural fistula is a communication between the pulmonary parenchyma distal to a segmental bronchus and the pleural space. A postoperative pulmonary expiratory air leak after an anatomic pulmonary resection is usually managed conservatively. The use of endobronchial valves is a minimal invasive method that may be effective for the treatment of a persistent postoperative pulmonary air leak. We present and discuss the advantages of a digital thoracic drainage system for the accurate, objective and reproducible air leak assessment during endobronchial valve placement...
2012: Respiration; International Review of Thoracic Diseases
Antoni Rosell, Rosa López-Lisbona, Noelia Cubero, Carme Obiols, Francisco Rivas, Jordi Dorca
The persistent air leaks due to alveolopleural fistula are not an uncommon complication of pneumothorax, particularly secondary ones. Unidirectional flow endobronchial valves designed for lung volume reduction are the latest incorporation to the therapeutic armamentarium. We present the case of a patient with chronic obstructive pulmonary disease (COPD) with persistent pneumothorax in spite of treatment with three pleurodesis which was able to be resolved with the placement of two IBV™ valves.
July 2011: Archivos de Bronconeumología
C Andreetti, M Ibrahim, A Ciccone, A D'Andrilli, C Poggi, G Maurizi, A Pavan, E A Rendina
Postoperative alveolar fistula (AF) associated with pleural cavity (PC) is a serious complication and a therapeutic challenge in thoracic surgery. The purpose of this study was to assess the efficacy of the use of the autologous platelet gel for the treatment of AF and PC. We treated a patient with post lung resection persistent alveolar fistula using a autologous platelet gel, a cellular compose produces at the Division of Immunohaematoligy and Trasfusion. The platelet gel-PRP (Platelet-Rich Plasma) is a biological material made of autologous platelets, extracted from a small amount of the patient's blood, centrifuged at 1100 g for 9 min...
December 2010: Minerva Chirurgica
P L Filosso, R Giobbe, L Brussino, E Ruffini, A Oliaro
The management of persistent air leaks (PALs) is one of the most common problems in general thoracic surgery, especially after elective pulmonary resections. The statistically most frequent air leak is caused by alveolar-pleural fistula (APF), which is defined as a link between the pulmonary parenchyma distal to a segmental bronchus, and the pleural space. Prolonged air leaks result in an increase in patient's hospital length of stay with possible infectious complications, aside from an overall hospitalization cost increase...
October 2010: Journal of Cardiovascular Surgery
Muhanned Abu-Hijleh, Michael Blundin
Bronchopleural (BPF) and alveolar-pleural (APF) fistulas are frequently encountered in clinical practice with persistent air leaks that can lead to significant morbidity, prolonged hospital stay, and potentially increased mortality. BPF and APF are commonly related to pulmonary resections. Other etiologies include minimally invasive procedures (thoracentesis and image-guided biopsies), and spontaneous fistulas related to an underlying structural lung disease (e.g., emphysema) or a necrotizing pulmonary process (e...
June 2010: Lung
Evan Woo, Bien-Keem Tan, Chong-Hee Lim
Pleural space problems after lung resection and persistent air leaks are among the commonest challenges posed to thoracic surgeons. Surgical repair of air leaks are indicated when conventional tube thoracostomy has failed to solve the problem. We would like to propose the novel application of the combined latissimus dorsi-serratus anterior transposition flap for selected cases of air leaks that are recalcitrant to conventional treatment. We discuss its indications and the surgical technique. Five patients underwent the procedure between 2004 and 2007...
August 2009: Annals of Plastic Surgery
Jurgen Passage, Robert Tam, Morgan Windsor, Mark O'Brien
BACKGROUND: Alveolar air leaks and broncho-pleural fistulae after thoracic surgical procedures contribute significantly to hospital morbidity and mortality. BioGlue has offered the thoracic surgeon an alternative to the products presently used to reduce the incidence of these complications. This retrospective study reviews our experience with this new adhesive. METHODS: Forty patients upon whom BioGlue was used were identified through operation records. Pre-, intra- and postoperative data were collected to establish use, indications and outcome...
May 2005: ANZ Journal of Surgery
Yasushi Sakamaki, Tetsuo Kido, Takashi Fujiwara, Katsuki Kuwae, Motomu Maeda
We treated a patient with postlobectomy persistent alveolar fistula using a tissue expander, which is a prosthesis widely used in plastic surgery. The patient had thoracic empyema develop after right bilobectomy for lung cancer, and consequently underwent drainage of empyema followed by muscle flap closure for alveolar fistula. A residual space remained, and air leak persisted. However, implanting and expanding a tissue expander enabled us to tightly fix the flap on the raw pulmonary surface, which eventually solved the air leak...
June 2005: Annals of Thoracic Surgery
David B Loran, Kenneth J Woodside, Robert J Cerfolio, Joseph B Zwischenberger
Persistent air leaks are caused by the failure of the postoperative lung to achieve a configuration that is physiologically amenable to healing. The raw pulmonary surface caused by the dissection of the fissure often is separated from the pleura, and the air leak fails to close. Additionally, higher air flow thorough an alveolar-pleural fistula seems to keep the fistula open. Other factors that interfere with wound healing, such as steroid use, diabetes, or malnutrition, can result in persistence of the leak...
August 2002: Chest Surgery Clinics of North America
M Famos, J Hasse, E Grädel
Residual pneumothorax may result in spite of correct pleural drainage after lobectomy, segmental or wedge resection. This is due to persistent alveolar or bronchiolar air fistula particularly often in combination with a discrepancy between the size of the pleural cavity and the remaining lung tissue as in bilobectomy. The management of this problem is dealt with on the base of experiences with 56 cases in a consecutive series of 250 patients. It is shown that in a stabilized situation - mostly after 10 to 14 days - pleural drainages safely can be removed and spontaneous resorption of a residual pneumothorax can be expected without further treatment even after intervals of several months on an outpatient base...
June 1980: Helvetica Chirurgica Acta
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