CTICasesPost-Pneumonectomy Bronchopleural Fistula and Empyema
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[...]. Post-Pneumonectomy Bronchopleural Fistula and Empyema. CTICases. Published March 24, 2014. https://str-case-explorer.pages.dev/c/d88mc
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.
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