支气管胸膜瘘

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CASE 1

History: A 75-year-old man post-op day 6from right lower lobe wedge resection for adenocarcinoma.男，75岁，右下肺腺癌楔形切除术后6天

患者术后经胸腔插管引流，但平片示液气胸持续存在，故行CT平扫：

根据目前的平片与CT，液气胸持续存在最可能的原因是（单选）？

1、手术所致空气、液体残留，胸膜反应，属正常情况，继续引流即可；
2、术后胸膜腔产气菌感染，化脓性炎症；
3、支气管胸膜瘘
4、食管胸膜瘘

Findings

Unenhanced chest CT shows a righthydropneumothorax with a direct communication between the right lower lobebronchial tree and the pleural space.

平扫CT显示：右侧液气胸，右下叶支气管与胸膜腔直接相通（箭）

Differential diagnosis 鉴别诊断：

Bronchopleural fistula 支气管胸膜瘘

Empyema 脓胸

Esophagopleuralfistula 食管胸膜瘘

Diagnosis: Bronchopleuralfistula

诊断：支气管胸膜瘘

Clinicaloverview

A bronchopleuralfistula (BPF) refers to an abnormal communication between the pleural space andbronchial tree.

Mostoften due to pulmonary resection and occurs in up to 9% of pneumonectomies.

Morecommon after right-sided pneumonectomy.

Predisposingfactors include uncontrolled preoperative pleuropulmonaryinfection, trauma, preoperative radiation therapy, and postoperativeventilation.

Signs/symptomsmay include purulent sputum, fever, cough, chest pain, or large air leak frompleural drainage tubes.

Associatedmortality rate of 16% to 23% has been reported.

Upto a third of BPFs may close spontaneously; however, surgery is usuallynecessary.

支气管胸膜瘘（BPF）指胸膜腔与支气管树之间异常交通。最常见于肺切除术后，发生率约9%，更多见于右肺手术后。发病诱因包括：手术前未控制的胸膜-肺部感染、创伤、术前放疗、术后机械通气.临床表现可包括脓痰、发热、咳嗽、胸痛，或从胸腔引流管排除大量空气。据报道死亡率达到16%-23%。

1/3 BPF可自愈，但通常需要外科手术。

Imaging findings

Persistent or progressive pneumothoraxdespite adequate tube drainage.Increased air and decreased fluid in thepostpneumonectomy space.Sudden pneumothorax or reappearance ofair in a previously opaque postpneumonectomy space.CT may allow direct visualization offistula.

Contrast administered directly intopleural collection may be visible in airways.

影像学表现：

持续或渐进性存在的气胸，尽管经过充分的引流；肺切除术后胸腔空气增多、液体减少.在之前肺切除术后的不透明空间突发气胸或再现空气.CT或许直接显示瘘管.将造影剂直接注入胸膜腔，或许会在气道中见到造影剂。

Differential diagnosis

Empyema: BPF may either cause or coexistwith empyema; pleural enhancement on contrast-enhanced study.

Esophagopleuralfistula: Imaging findings similarto BPF;endoscopy generally required to locate esophageal tear.

鉴别诊断：

脓胸：BPF可为脓胸的病因，也可与脓胸并发；增强扫描可见胸膜增厚。

食道胸膜瘘：影像学表现与BPF类似，通常需要食道内镜确定食道破裂部位。

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