• Journal of Chest Surgery
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• v.23 no.6
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• pp.1275-1279
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• 1990

Esophagopleural fistula is a rare complication that should be suspected in all patients with recurrent empyema following pneumonectomy and in whom a bronchopleural fistula can be excluded. In late postpneumonectomy esophagopleural fistula, diagnosis is difficult due to its rarity and no specific symptom and sign, but we have experienced a man who had suffered dysphagia and odynophagia. In surgical treatment of late postpneumonectomy esophageal fistula, closure of empyema space is of prime importance. We have adopted a type of latissimus dorsi muscle and serratus anterior muscle flap transposition We present here this technique and result obtained in patient with late postpneumonectomy esophagopleural fistula.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.63-66
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• 1996

Postoperative empyema thoracis with bronchopleural fistula (BPF) Is uncommon but serious complication. The management remains troublesome area in the field of the general thoracic surgery During the period of October 1993 to December 1994, four patients with postresectional empyema thoracic with BPF were treated consecutively in Ewha Womans University Mokdong Hosp tal. The treatment procedures include irrigation and debridement of the empyema cavity and muscle flap transposition. Follow-up periods after surgery were 4-12 months. Three patients were thought successful, one patient failed. We think that the cause of failure is muscle necrosis of rectos abdominis muscle flap due to vascular injury and infection of muscle due to residual infected debridement of empyema cavity.

• Journal of Chest Surgery
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• v.27 no.8
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• pp.677-682
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• 1994

A bronchopleural ~stula[BPF] is a major therapeutic challange to the thoracic surgeons due to difficulties in its management. We have experienced 9 cases of postpneumonectomy BPF, and all of them occured after the right side pneumonectomy. Seven patients underwent pneumonectomy due to lung cancer, and one patient each received pneumonectomy due to bronchiectasis and pulmonary tuberculosis. The most frequently used method of treatment was Eloesser operation which was done in 7 patients, and one had open thoracostomy and one had betadine irrigation until he died suddenly due to pulmonary vein rupture. The result of treatment was poor with five mortalities including one operative death. Two patients are in good condition in 28 months and 4 years of follow-up, but two are lost in follow-up. Tissue sealant such as Tisseel was used in three patients but seems to have no effect at all in the treatment of postoperative BPF.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.107-111
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• 1996

Persistent bronchopleural fistula (BPF) still presents a troublesome therapeutic challenge and demands an aggressive approach when conventional measures fail. A 50-year-old man had a rigtlt pneumonectomy for far-advanced pulmonary tuberculosis with the development of postopneumonectomy empyema and BPF 1 month postoperatively in October 1 81. The condition was managed with BPF closure and the Clagett procedure, which failed with the recurrence of BPF and empyema, followed by a spontaneous open window at about 1 year port:operatively. The BPF, which had been aggravated to a large size, was managed by the closure and obliteration of the empyema cavity using a Pectoralis-skin pedicled flap 13 years postoper atively on Jul, 1994. The BPF was controlled by the procedure, and the patient, with improved respiratory symptom, was discharged 43 days postoperatively. We conclude that the use of myocutaneous flap Is an effective procedure for the closure of a large BPF. The surgical technique of the pedicled flap operation is described and the case is reported.

• Tuberculosis and Respiratory Diseases
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• v.51 no.1
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• pp.70-75
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• 2001

Aspergillosis refers to an infection with any species from the genus Aspergillus. Pleural aspergillosis is an uncommon disease with less than 30 cases having been reported in the literature since 1958. The etiologic factors for this aspergillosis are preexisting pulmonary tuberculosis, bronchopleural fistula, pleural drainage, and a lung resection. Surgical removal of the aspergillus-infected pleura is the main treatment for managing this disease. We have experienced two cases of pleural aspergillosis as a complication of a preexisting chronic empyema. The chest radiographs showed a pyopneumothorax with cavitation and the chest computed tomographic scans revealed a loculated pyopneumothorax with cavity formation suggesting a bronchopleural fistula. A grossly purulent fluid was extracted by thoracentesis, and Aspergillus fumigatus was grown from a fungus culture of the fluid. A decortication, wedge resection with a pleurectomy and a pleuropneumonectomy were performed. The postoperative course was satisfactory and the patients have been in good condition up to now. Pleural aspergillosis is a very rare and potentially life-threatening disease. However, good result without significant complication were obtained by treatment with systemic antifungal agents and surgical removal.

• Tuberculosis and Respiratory Diseases
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• v.58 no.4
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• pp.404-409
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• 2005

An 86 year old woman was admitted complaining of dyspnea and right pleuritic pain with a 5 week durations. A physical examination, chest X-ray, and diagnostic thoracentesis upon admission revealed findings consistent with severe pneumonia and empyema on the right lung. Despite the insertion of a chest tube and negative suction via Emersion pump, the continuous air leakage was sustained, and a bronchopleural fistula (BPF) was found on the chest-CT. A flexible bronchoscopic occlusion with an Endobronchial Watanabe Spigot (EWS) was performed after 56 days of admission. An 5 mm diameter EWS was successfully inserted into the anterior segmental bronchus of the right upper lobe by flexible bronchoscope. There was no aAir leakage detected after this procedure. The patient was discharged 30 days after the EWS occlusion.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.285-291
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• 1980

Post pneumonectomy empyema either with bronchopleural fistula or without bronchopleural fistula is an infrequent postoperative complication, but very serious and critical problem. But it is of some interest that the development of a postoperative empyema following resection for carcinoma of the lung might have a favorable effect on the survival of patients in recent speculation of the literature. We have experienced 4 cases of postoperative empyema following pneumonectomy for carcinoma of the lung at department of chest surgery, Yon Sei University, medical college during 11 years from Jan. 1968 to June 1980. Histologically, 3 cases were demonstrated squamous cell carcinoma except one oat cell carcinoma. Onset of postoperative empyema occurred over a wide range of time, from as early as the 5th postoperative day to insidious onset 6 months after pneumonectomy. The most common organisms isolated from the empyema cavities were staphylococcus aureus, pseudomonas aeruginosa and gram negative bacilli. All cases had a large number of organisms and more infections but not single infection. 2 out of 4 cases are treated with open pleural window drainage and irrigation with antibiotic`s solution 2 or 3 times per week by this time and postoperative general course is not eventful. One is alive to 2 years 3 months, another is alive to 8 years 11 months until now. And 2 out of 4 patients is survived over 4 years 10 months. Analysis of postoperative empyema complicating pneumonectomy for bronchogenic carcinoma revealed an increase in 4 year 10 months survival [50%].

• Journal of Chest Surgery
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• v.22 no.4
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• pp.648-654
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• 1989

A clinical study was performed on 363 cases of pulmonary tuberculosis treated surgically resection during the period of 3 years from January, 1986 to December, 1988 in the National Kong-Ju Hospital. The results obtained are follows: 1. The ratio of male to female was 1.6:1 in male predominance, age from 20 to 40 occurred 82.6% of the total cases. 2. The moderately advanced cases was the highest incidence with 53.2 % for extent of disease, duration of illness which 1 to 5 years before operation was 40.8 % of the total cases. 3. Preoperative sputum examination for AFB was 53.2 % in negative but in spite of chemotherapy, persistent positive sputum was 46.7%. 4. Indication for surgery were: total destroyed lung was 35.5 %, destroyed lobe or segment with or without cavity was 30.6%, empyema with or without bronchopleural fistula was 8.5%, according to type and site of surgical procedure, pleuropneumonectomy and pneumonectomy was the highest incidence with 53.4 %, left site was slightly more than right with 55.9 % of the total cases. 5. The incidence of postoperative complication was 10.2 % and then the highest incidence was empyema with or without bronchopleural fistula with 4%, according to type of surgical procedure, postpleuropneumonectomy and postpneumonectomy was 6.1 % of the total cases. 6. Postoperative mortality was 1.4 % of the total cases, according to cause of deaths, hypovolemic shock due to bleeding were 2 cases, respiratory failure were 2 cases and hepatic coma due to hepatic failure was 1 case.

• Journal of Chest Surgery
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• v.7 no.2
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• pp.139-144
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• 1974

Clinical observations were made on 513 cases of pulmonary resection for tuberculosis, those were treated at the Department of Thoracic Surgery in National Medical Center from January 1964 to December 1973. 1. The ratio of male to female cases of operation was 2.8:1 in male predominence and age from 21 to 30 occurred 74.3% of the total cases. 2. The extent of disease showed 59.3% moderately advanced, 38.4% far advanced and 2.3% minimal cases. Duration of chemotherapy before surgery was more than one year in 92.7% and only 7.3% was treated less than one year. Preoperative sputum examination for AFB was persistent negative in 8.6,% of cases. 3. Different operative procedures were performed in 513 cases, lobectomy in 230, pneumonectomy and Pleuropneumonectomy in 172, segmentectomy in 63, lobectomy and supplemental segmentectomy with conventional thoracoplasty in 32 cases. 4. The postoperative complications occurred in 67 cases [13.0%]. Of these complications, bleeding in 4.6% , dead space problem in 2.5% and empyema with or without bronchopleural fistula occurred in 2.3% of cases. 5. Overall mortality within 5 months postoperative period was 1.5,0/0 and the most common causes of death were due to shock and empyema with bronchopleural fistula. 6. In all our 867 cases of report I and II, complications occurred in 13.9% and mortality rate was 1.8%.

• Journal of Chest Surgery
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• v.24 no.8
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• pp.782-791
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• 1991

In Pusan Paik Hospital, Inje University, we experienced 174 cases of pulmonary resections for pulmonary tuberculosis from Jun. 1979 to Feb. 1990. In all of them automatic stapling devices were used for division of lung parenchyme and /or bronchial closure. The results were as follows; l. In 174 cases[male 100, female 74], third and fourth decades were 116 cases [66.7%]. 2. Indications for lung resection in the radiographic findings were destroyed lung 47 cases[27.0%], destroyed lobe 42 cases[24.1%], cavitary lesions 42 cases[24.1%], tuberculoma 22 cases[12.7%], and bronchial lesions 21 cases[12.1%]. 3. The mean of staplers used in the operations was 1.6, and possible stapler-associated complications were only 2 cases of bronchopleural fistula after pneumonectomy. 4. Twenty-seven of 36 patients with bilateral lesions and 52 of unilateral ones on chest X-ray films were AFB positive on preoperative sputum smears. Twenty-three[85.2%] of bilateral lesions and 51[98.1%] of unilateral ones were AFB negative at 6 months after operations. 5. Main complications of resections were operative death 1[0.6%], empyema 4[2.3%], respiratory insufficiency 3[1.7%], pleural dead space 5[2.9%], and bronchial spreading of tuberculosis 2[1.1%]. Bronchopleural fistula were only 2 cases after pneumonectomy and none after lobectomy or segmentectomy. 6. One hundred and forty two patients[92.8%] of 153 with available follow-up data were in the state of good quality of life.