title: Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement.
abstract: OBJECTIVE
  To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings.
  
  
  METHODS
  We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists.
  
  
  RESULTS
  The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion.
  
  
  CONCLUSIONS
  In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Yoon
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Chung
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 22332, Korea.
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
authors.forename: Hye Yun
authors.initials: HY
authors.lastname: Park
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005402:Fistula / Q000150:complications; D006801:Humans; D006872:Hydropneumothorax / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009162:Mycobacterium avium / Q000302:isolation & purification*; D015269:Mycobacterium avium Complex / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis* / Q000382:microbiology; D010995:Pleural Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology; D010996:Pleural Effusion / Q000150:complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Broncho-pleural fistula; Computed tomography; Hydropneumothorax; Lung; Mycobacterium avium complex; Pleural effusion