CTICasesPost-Pneumonectomy Bronchopleural Fistula and Empyema
▶ Watch on YouTube — age-restricted, cannot embed here
Imaging findings
Serial chest radiographs show post-pneumonectomy fluid initially occupying 95% of the right hemithorax. Twelve days later, there is a sudden, significant decrease in fluid and an increase in air-fluid levels despite the patient being asymptomatic. Follow-up CT demonstrates persistent gas-fluid levels, splaying of the ribs at the thoracotomy site indicating surgical dehiscence, and a large empyema tracking through the posterior chest wall with subcutaneous emphysema.
Key takeaways
Bronchopleural fistula and bronchial stump dehiscence are life-threatening post-pneumonectomy complications. Any sudden decrease in the fluid level or appearance of new air-fluid levels in the post-pneumonectomy space on serial chest radiographs is highly suspicious for a bronchial stump leak, even in an asymptomatic patient. Associated findings like thoracotomy dehiscence and chest wall empyema further support the diagnosis, which requires urgent surgical repair and muscle flap closure.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Mediastinal Teratoma Mimicking Pericardial CystNeoplastic
- Unilateral Pleural Metastasis from OsteosarcomaNeoplastic
- Metastatic Pulmonary CalcificationMetabolic
- Sternal MRSA OsteomyelitisInfection
- Pseudoaneurysm and Transient Aortic Occlusion following Coarctation RepairVascular
- Multifocal Lung AdenocarcinomaNeoplastic
- Centrilobular Emphysema Mimicking LymphangioleiomyomatosisExposure
- Anastomotic Bronchial Stenosis after Lung TransplantationIatrogenic
See all cases from March 24, 2014 →