CTICasesMycobacterium abscessus with Tracheopleural Fistula
Imaging findings
A man in his late 50s who had an upper lobectomy for early-stage lung cancer developed a persistent cavity that grew Mycobacterium abscessus after multiple treatments. Imaging shows a tracheopleural fistula communicating with the chest wall, in-brought muscle flaps, background airway colonization with small airway nodules and secretions, and signs of chronic inflammation including rib hyperostosis and extrapleural fat hypertrophy. The surgeons have effectively created a Claggett-type window that is difficult to keep closed because of the fistula.
Key takeaways
Mycobacterium abscessus is an aggressive rapidly growing mycobacterium that causes cavitary disease, is very difficult to eradicate, and is often a transplant contraindication. A tracheopleural fistula communicating with the chest wall behaves like a bronchopleural fistula and severely impairs ventilation, requiring bulky soft-tissue flap coverage (such as pectoralis rotation flaps) to keep the space closed, and represents a formidable surgical management problem given the underlying infection and poor lung reserve.
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