1/25. Aorto-bronchial fistula after implantation of a self-expanding bronchial stent in a patient with aortic dissection.We report a case of aorto-bronchial fistula after implantation of a self-expanding stent into the left main bronchus compressed by a dissected descending aorta. A 66-year-old female, who underwent Stanford type-B aortic dissection two years previously, was admitted to our hospital for the treatment of a newly developed false lumen that originated from the ascending aorta and extended to the aortic bifurcation. She was unable to be weaned from the respirator after the graft replacement of the ascending aorta. Fiberoptic bronchoscopic examination revealed complete obstruction of the left main bronchus by extrinsic compression. A self-expanding nitinol stent was implanted in the left main bronchus five days after the operation. Her respiratory condition improved remarkably, allowing her to be successfully weaned from the respirator. Her clinical course was uneventful until she suddenly died from massive hemoptysis 20 days after stent implantation. A communication of 5 mm in diameter between the dissected descending aorta and the left main bronchus was seen at autopsy. Permanent application of a self-expanding nitinol stent to relieve extrinsic compression of a left main bronchus by a dissected descending aorta is not recommended because pressure necrosis might lead to fatal aorto-bronchial fistula.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/25. Horizontal gradient in ventilation distribution due to a localized chest wall abnormality.Horizontal gradients in the distribution of ventilation and of regional vital capacities, as well as a reversed vertical, esophageal pressure gradient, were observed in a patient with a unilateral painful chest wall lesion. The distribution abnormalities disappeared after surgical treatment. These findings suggest that the interdependency between chest wall and lungs, and within the latter, between lobes, is an important factor determining the regional distribution of ventilation and the pleural pressure gradient in man.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/25. Treatment of postoperative bronchobiliary fistula by nasobiliary drainage.Bronchobiliary fistula (BBF) is a rare condition. It may present as a complication of echinococcal or amebic liver disease. Management of such a fistula can be very difficult and is often associated with a high rate of morbidity and mortality. We report the case of a 70-year-old woman who presented with a BBF after a one-stage operation for hydatid cysts of the liver and lung that were approached via thoracotomy and transdiaphragmatic incision. The cause of the BBF was an inflammatory collection in the residual liver cavity due to inadequate drainage. This collection eroded the sutured diaphragm, and because of the existing adhesions, it perforated directly into the bronchial system at the area of the previous cystectomy. Initially, endoscopic sphincterotomy was performed to achieve biliary decompression by equalizing intrabiliary and duodenal pressure, but no significant improvement was seen. Subsequently, nasobiliary drainage was instituted by means of an endoscopically inserted, nasobiliary catheter, which further reduced biliary pressure and facilitated biliary flow to the duodenum, as opposed to the fistulous tract. The fistula was successfully closed in a short time. This conservative method reduces the risks of reoperation. Therefore, it should be considered the treatment of choice in the management of bronchobiliary fistula.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/25. Management of tension pneumatocele with high-frequency oscillatory ventilation.We report the successful application of high-frequency oscillatory ventilation in a patient with tension pneumatocele (TP). The proposed check-valve mechanism for the development of pneumatoceles predicts that positive-pressure ventilation could lead to distension of these airspaces and formation of TPs. Therefore, high-frequency ventilation could be more applicable in conditions, such as massive air leak due to bronchopleural fistula, that are difficult to manage by conventional ventilator modes.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/25. Management of neonatal bronchovenous fistula after cardiopulmonary bypass.Bronchovenous fistula is occasionally encountered after traumatic lung injury or, in neonates, due to ventilation injuries with high ventilatory pressures. We report a case of massive air embolism associated with a bronchopulmonary venous communication in an infant post-repair of truncus arteriosus. Selective ventilation of the opposite lung for 3 days sealed the fistula.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/25. Bullets and biliptysis.Biliptysis is a dramatic physical finding which suggests the presence of a direct communication (fistula) between the biliary and bronchial tree. We report a bronchial biliary fistula resulting from penetrating thoracoabdominal trauma and the use of positive-pressure ventilation to obtain initial fistula control prior to definitive surgical repair.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/25. High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report.PURPOSE: To describe the use of high frequency oscillatory ventilation (HFOV) in the management of a high output bronchopleural fistula (BPF). CLINICAL FEATURES: A 55-yr-old female developed a BPF after thoracotomy and decortication of an empyema. The patient deteriorated on the second postoperative day (pH 7.10 PCO2 89) requiring 100% oxygen and mechanical ventilation. After initial improvement, deterioration occurred by 24 hr with conventional positive pressure ventilation (volume or pressure limited) because of decreased pulmonary compliance and bilateral diffuse airspace disease (acute respiratory distress syndrome), persistent increased peak and plateau airway pressures, a prolonged inspired oxygen concentration greater than 0.6, and inability to apply positive end expiratory pressures because of an increased BPF leak (530 mL.breaths(-1)). HFOV was initiated and maintained for 28 days until resolution of the airspace disease and decreased leak through the BPF to 100 mL.breaths(-1). CONCLUSION: We report the successful use of HFOV in a patient with high output BPF. We suggest that HFOV is a useful technique in patients with a BPF when conventional positive pressure ventilation fails.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
8/25. Treatment of a transdiaphragmatic fistula with an endobronchial-blocking catheter.We report a case of a bronchosubphrenic fistula in a 59-year-old female following hemicolectomy complicated by fecal peritonitis. The patient needed intubation and positive-pressure ventilation, which caused a massive air leak. The fistula was treated using an endobronchial blocking catheter in combination with antibiotic treatment and drainage.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/25. Surgical field fire during a repair of bronchoesophageal fistula.Most surgical fires involve the airway but they can also occur in the surgical field. Herein, we report an intraoperative fire in the surgical field during repair of a bronchoesophageal fistula. During the portion of the surgery after the fistula was divided and the bronchus was open to atmosphere, continuous positive airway pressure was applied to the nondependent lung, and in conjunction with the use of electrocautery and dry sponges in the field, resulted in a fire. anesthesia for thoracic surgery carries unique risks of fire because these patients frequently require large oxygen concentrations, special interventions for improving oxygenation, and have variable degrees of airway disruption. This report highlights unique safety concerns during anesthesia for thoracic surgery, and addresses more general safety issues relating to fire risk in all surgical patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/25. Bronchocutaneous fistula after chest-tube placement: A rare complication of tube thoracostomy.Bronchocutaneous fistula is a pathologic communication between the bronchus, pleural space, and subcutaneous tissue. It can occur as a complication of positive pressure ventilation and pneumonectomy. diagnosis is made by imaging studies. Treatment options are endoscopic repair, parietal pleurectomy, and pleurodesis. Our patient is a 53-year-old woman who had a difficult chest-tube placement for complicated parapneumonic effusion. Computed tomography scan revealed a fistulous tract from the bronchus to the skin at the site of the original chest tube, and chest x-ray film revealed a subcutaneous fistulous air tract in the lateral chest. It is usually an acquired condition; congenital bronchocutaneous fistula is rare. We report a case of bronchocutaneous fistula after chest-tube placement.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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