Ann Thorac Surg 2006;82:750
© 2006 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Bilateral Pulmonary Pleural Fistula Combined With Traumatic Retro-Pharyngeal Abscess
Do Hyung Kim, MD,
Kyung Jun Won, MD,
Kil Dong Kim, MD*
Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, Korea
* Address correspondence to Dr Kim, Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, 1306 Seo gu Dunsan dong, Daejeon, 302-120 Korea. (Email: kdkimmd{at}eulji.ac.kr).
A 9-month-old male baby visited our hospital due to severe dyspnea that had developed 2 days previously. He had had a fever and a cough for approximately 4 weeks and had undergone removal of a tack in the pharynx 3 weeks previously. The tack had been accidentally found on a chest roentgenogram that had been taken in order to evaluate the fever's origin (Fig 1).
The chest roentgenogram at admission (Fig 2) showed abnormal gas shadows from the retro-pharynx to the upper mediastinum, and there was bilateral mediastinal bulging contours with internal gas formation. Computed tomography (Fig 3) demonstrated bilateral empyema sacs communicating with each other in the posterior mediastinal cavity; furthermore, there was air and necrotic materials in the mediastinal cavity and in the empyema sacs. We performed an emergency operation through a right posterolateral thoracotomy. After debridement of the purulent materials in the posterior mediastinal and bilateral thoracic cavities, the pulmonary pleural fistula of the right upper lobe and the retro-esophageal cavity with a fistulous connection between the mediastinal pleura and the left thoracic cavity were discovered.
The patient underwent wedge resection of the right upper lobe that included the pulmonary pleural fistula, and a chest tube was positioned in the orifice of the fistulous tract to the left thoracic cavity through the posterior mediastinum. On postoperative day 7 an air pocket was newly developed in the left thoracic cavity; therefore, the patient underwent a second operation. We performed left posterolateral thoracotomy, and minor air leakage of the necrotized lung tissue in the left upper lobe was found. Wedge resection of the left upper lobe was performed, and the patient was finally discharged on postoperative day 8 after the second operation in excellent general condition.
