ABSTRACT
Pleural space diseases constitute a wide range of benign and malignant conditions, including pneumothorax, pleural effusion and empyema, chylothorax, pleural-based tumors, and mesothelioma. The focus of this article is the surgical management of the 2 most common pleural disorders seen in modern thoracic surgery practice: spontaneous pneumothorax and empyema.
Subject(s)
Chylothorax , Empyema , Pleural Diseases , Pleural Effusion , Pneumothorax , Chylothorax/etiology , Chylothorax/surgery , Humans , Pleural Diseases/surgery , Pneumothorax/surgeryABSTRACT
Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.
Subject(s)
Bronchial Fistula/surgery , Bronchoscopy , COVID-19/complications , Empyema, Pleural/surgery , Pleural Diseases/surgery , Surgical Instruments , Bronchial Fistula/etiology , Chest Tubes , Empyema, Pleural/etiology , Humans , Male , Middle Aged , Pleural Diseases/etiology , SARS-CoV-2 , ThoracostomyABSTRACT
BACKGROUND: The main clinical consequences of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are pneumonia and respiratory failure even requiring mechanical ventilation. In this context, the lung parenchyma is highly prone to ventilator-related injury, with pneumothorax and persistent air leak as the most serious adverse events. So far, endobronchial valve (EBV) positioning has proved efficacious in treating air leaks with a high success rate. CASE PRESENTATION: We report, for the first time, two cases of patients affected by SARS-CoV-2-related pneumonia complicated with bacterial super-infection, experiencing pneumothorax and persistent air leaks after invasive mechanical ventilation. Despite the severity of respiratory failure both patients underwent rigid interventional bronchoscopy and were successfully treated through EBV positioning. CONCLUSIONS: Persistent air leaks may result from lung tissue damage due to a complex interaction between inflammation and ventilator-related injury (VILI), especially in the advanced stages of ARDS. EBV positioning seems to be a feasible and effective minimally invasive therapeutic option for treating this subset of patients.
Subject(s)
Bronchial Fistula/surgery , COVID-19/therapy , Pleural Diseases/surgery , Pneumothorax/surgery , Respiration, Artificial/adverse effects , Aged , Bronchoscopy/methods , COVID-19/diagnosis , Humans , Intensive Care Units , Male , Respiratory Tract Fistula/surgery , SARS-CoV-2/genetics , Tomography, X-Ray ComputedABSTRACT
We report a case of necrotizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia complicated by a bronchopleural fistula and treated by decortication and salvage lobectomy. Owing to the unknown characteristics of the underlying SARS-CoV-2 infection, treatment of the abscess and bronchopleural fistula was delayed. This may have resulted in further deterioration of the patient, with ensuing multiple organ dysfunction. Complications of SARS-CoV-2 pneumonia, such as a bacterial abscess and a bronchopleural fistula, should be treated as if the patient were not infected with SARS-CoV-2.