Early detection of occult bronchopleural fistula after routine standard pneumonectomy.
OBJECTIVE
The aim of this study was to define symptoms and signs for early diagnosis of occult bronchopleural fistula (OBPF) after routine pneumonectomy.


METHODS
From 1999 to 2003, 301 pneumonectomies for malignancy were performed. The records of these patients were retrospectively analyzed for several clinicopathologic factors. All patients (group A) that presented postoperatively with one or more suspicious symptoms and signs were recorded. These cases were grouped according to bronchopleural fistula documentation (group A1) or not (group A2). Both groups were subjected to multivariate analysis.


RESULTS
In 10 cases (3.3%) bronchopleural communication was confirmed (group A1). The most frequent signs included the lack of contracture or even enlargement of postpneumonectomy space (52.7%), subcutaneous emphysema (33.3%), fever (27.7%), respiratory insufficiency (27.7%), and cough (22.2%). Multivariate analysis disclosed failure of the postpneumonectomy space to contract as an independent prodromal sign for bronchopleural communication (P=0.03, odds ratio 58.3, 95% CI: 1.45-2335.9).


CONCLUSIONS
Chest radiology proved to be the diagnostic modality of choice for early detection of bronchopleural fistula.
Misthos
P
P
Thoracic Surgical Department, SOTIRIA General Hospital for Chest Diseases, Athens, Greece. panmisthos@yahoo.gr
Konstantinou
M
M
Kokotsakis
J
J
Skottis
I
I
Lioulias
A
A
D000368:Aged; D001983:Bronchial Fistula / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies