Demonstration of a bronchopleural fistula by ventilation lung scanning

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Lung scanning by xenon 133 (133Xe) ventilation is a study that is easy to perform and may be diagnostic of bronchopleural fistula when other routinely employed procedures such as methylene blue instillation, fiberoptic bronchoscopy, and bronchography are not helpful.

The incidence of bronchopleural fistulae following pulmonary resection in one large series was 2.7%.1 The mortality in this series was 16.4%, but it can be as high as 23% to 67%.2, 3 In view of the present epidemic of lung cancer,4 with a concomitant increase in the number of operations, postoperative complications would also be expected to increase. However, the incidence of bronchopleural fistulae may vary from center to center, with an obvious bronchial stump leak being the only entity of assured recognition.5 A small leak may not be recognized initially, and possibly may lead to increased morbidity or even mortality at a later date. We report a case of a postpneumonectomy bronchopleural fistula in which xenon lung scanning confirmed the diagnosis.

Case report

A 58-year-old diabetic black male with suspected tuberculosis was admitted because of a positive intermediate PPD skin test and a right upper lobe infiltrate. Sputum smears failed to show mycobacteria and fiberoptic bronchoscopy revealed epidermoid carcinoma. An extensive work-up including mediastinoscopy was negative, and a right pneumonectomy was performed. The bronchial stump was closed in two layers, using O Prolene. The pathology report revealed right hilar lymph node involvement with tumor and invasion of the right main stem bronchus. Prophylactic cephalothin was given postoperatively. Isoniazid therapy was begun . . .



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