Ambulatory management of bronchopleural fistulae secondary to empyema

Abstract

Ambulatory management of pneumothoraces and malignant pleural effusions is common, with occasional use in post-operative patients with persistent air leak. A literature review did not ascertain any prior description of ambulatory management of patients with bronchopleural fistulae secondary to empyema. We present a case series of 2 patients who received ambulatory management who were not suitable for surgical intervention.

Case 1. 69 year-old man admitted with a right hydropneumothorax and mediastinal shift. An empyema was confirmed on chest drain insertion. CT showed a bronchopleural fistula from abscess rupture. After a 4 week hospital stay, an ambulatory chest drain valve was fitted. He received outpatient managment for 2 weeks prior to chest drain removal. Follow up x-rays showed lung re-expansion with small residual pleural effusion.

Case 2. 75 year-old man presented with right lower zone consolidation and associated effusion. He required intubation and transfer to intensive care. A chest drain initially drained pus, then copious bubbling developed. CT showed a right sided pneumothorax, residual empyema and a bronchopleural fistula.

After an 8 week hospital stay, an ambulatory valve was placed and he was reviewed weekly in pleural clinic. He received outpatient management for 2 weeks prior to chest drain removal. Follow up has shown his lung remains re-expanded and he is doing well.

These cases demonstrate that, for certain patients, it is possible to safely manage bronchopleural fistulae secondary to empyema in an outpatient setting. This reduces hospital length of stay, decreases exposure to hospital associated infections and allows patients to recuperate at home with their family.