Identification of a bronchopleural fistula by computerized tomography--a case report

A case report is presented of a bronchopleural fistula demonstrated on computed tomography (CT) scan but not identifiable on plain radiographs. The case illustrates the importance of CT in evaluating the pleural space.     

Detection of a suspected bronchobiliary fistula by hepatobiliary scintigraphy

Bronchobiliary fistula (BBF) represents a rare but severe complication in patients affected by liver metastases. Although a clinical suspicion can arise when specific clinical signs, in particular biliptysis, are present, conventional imaging modalities often fail to confirm the diagnosis. We present a case of a patient affected by colon cancer with liver metastases previously treated with partial right-sided hepatectomy and multiple thermo-ablative treatments combined with chemotherapy, who manifested a septic fever associated with productive cough and biliptysis. Diagnosis of BBF was confirmed only by hepatobiliary scintigraphy with (99m)Tc-heptoiminodiacetic acid.     

支气管栓塞术治疗肺癌化疗后自发支气管胸膜瘘1例

1临床资料患者男,54岁。2020年10月2日因发现左侧气胸1 h入院。既往左肺鳞癌病史2个月(TNM,Ⅳ期,图1(1)),并行卡铂400 mg+紫杉醇240 mg化疗2个疗程(图1(2))。查体:体温36.9℃脉搏104次/min呼吸18次/min血压110/75 mmHg (1 mmHg=0.133 kPa),胸廓对称无畸形,肋间隙等宽,胸壁无压痛,浅表淋巴结未触及。     

Iatrogenic bronchopleural fistula caused by feeding tube insertion

Nutritional supplements administered through flexible small caliber feeding tubes are an increasingly popular substitute for parenteral hyperalimentation. Small and large caliber nasogastric tubes can inadvertently pass into the tracheobronchial tree, even in the presence of an endotracheal tube with an inflated cuff. We report three patients who had small caliber feeding tubes passed through the tracheobronchial tree perforating into the pleural space. Potential complications include immediate or delayed pneumothorax, tension pneumothorax, hydropneumothorax, and empyema. Prompt post-insertion chest radiography is required to verify correct placement of small caliber feeding tubes.     

Closure of bronchopleural fistula with Angio-Seal

Bronchopleural fistula is rare and occurs most often after trauma or surgery. Conservative management and support comprise the initial treatment, but if unsuccessful, surgical closure is usually required. We describe for what is to our knowledge the first successful use of an Angio-Seal vascular closure device in a patient who was not a candidate for surgery.     

Detection of tracheoesophageal fistula caused by ingestion of a caustic substance by esophageal scintigraphy

A 4-year-old boy was referred for scintigraphic evaluation of esophageal transit 24 hours after he had ingested sodium hydroxide. After oral administration of Tc-99m sulfur colloid, scintigraphy showed marked and prolonged retention of the radioactive bolus in the middle and lower thirds of the esophagus. Three weeks after ingestion of the caustic substance, repeat scintigraphy was requested to evaluate esophageal transit and gastric-emptying. In this presentation, a tracheoesophageal fistula was a consequence of sodium hydroxide ingestion and was identified with radionuclide scintigraphy before there was clinical and radiologic detection.     

组合式双“Y”形覆膜支架治疗右主支气管胸膜巨大瘘1例

临床资料 患者,男,46岁.病理确诊为食管中段低分化鳞状细胞癌.行食管癌切除、胃食管弓上吻合术.术后患者呼吸困难,气胸形成,诊断右主支气管胸膜瘘.术后第4天再行右主支气管漏修补+大网膜填充术.术后12 d,患者胃管、胸腔引流管持续引流出胸腔积液及气体,诊断为:再发右主支气管胸膜瘘合并食管吻合口瘘.患者已不能耐受外科手术.拟行组合式双“Y”形气管覆膜支架植入瘘口封堵术.     

Biliary pleural fistula detected by hepatobiliary scintigraphy

A biliary pleural fistula is a rare complication secondary to trauma, infection, malignancy, biliary disease, malignancies, or percutaneous procedures. Its presence may be suggested by the development of a right pleural effusion in a patient with such history and can be confirmed with a hepatobiliary scan or endoscopic retrograde cholangiopancreatography. Patients are treated with antibiotics and the fistula usually spontaneously closes. If after 2 weeks the fistula persists, percutaneous drainage, sphincterotomy, or biliary stent placement can be performed to promote healing of the fistula. In complicated cases, open thoracic surgery or video-assisted thoracic surgery may be required.     

冠状动脉-支气管动脉瘘一例

病史摘要 患者男,67岁.因反复发作胸闷、心悸6年加重5 d入院.患者6年前无明显诱因出现心悸、心动过速发作,伴胸闷.此后反复出现心悸发作,无明显胸痛,偶伴夜间阵发性呼吸困难,平时稍动则喘,不能登3楼.     

支气管胸膜瘘介入治疗及研究进展

支气管胸膜瘘是肺切除术后严重威胁患者生命的并发症。随着介入放射学的发展,支气管胸膜瘘的介入治疗方法也逐渐多样。本文就支气管胸膜瘘的介入治疗及研究进展进行综述。     

Aberrant cerebrospinal fluid pathway. Detection by scintigraphy

Radionuclide cisternography is routinely performed for assessment of normal and abnormal pathways and the hydrodynamics of cerebrospinal fluid (CSF). An unusual case of a woman in whom cisternography provided the diagnosis of an iatrosenic spinopleural fistula with a large CSF collection in the pleural cavity, following surgical resection of a vertebra for a malignant tumor is presented.     

Detection of miliary tuberculosis by Ga-67 scintigraphy.

Two patients are presented in whom pulmonary accumulation of Ga-67 led to an early diagnosis of miliary tuberculosis and its prompt treatment. Their chest radiographs were unremarkable and thus noncontributory to the diagnostic process.