Answer
Bronchopleural fistula (BPF): This generally occurs within 2 weeks of surgery and is recognized by the following radiographic features demonstrated on the ipsilateral hemithorax: an increasing quantity of air, a decreasing amount of fluid, the absence of a mediastinal shift, and the appearance of air in the pleural space 6 months after pneumonectomy. This patient underwent bronchoscopy as a further diagnostic procedure. A BPF in the left main stem bronchus was identified and is likely caused by tumor recurrence.
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BACKGROUND
A 76-year-old woman underwent left pneumonectomy for the treatment of a squamous cell carcinoma. A routine chest radiograph was obtained 6 months after the operation (see Image A). Two weeks later, the patient presents with a cough, a fever, and the production of large amount of brown sputum; another chest radiograph is obtained (see Image B). What is the abnormality shown on the most recent chest radiograph?
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Hint
This complication may occur in as many as 3% of patients undergoing pneumonectomy.
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Author:
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Sat Sharma, MD
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Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
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eMedicine Editor:
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Bruce Maycher, MD
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University of Manitoba
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eMedicine
Image Case
