A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.
Acinetobacter baumannii ; Bronchial Fistula ; Carbon Dioxide* ; Carbon* ; Chest Tubes ; Empyema* ; Fistula ; Humans ; Hydropneumothorax ; Hypercapnia ; Lung ; Lung Neoplasms ; Respiration, Artificial ; Respiratory Insufficiency ; Thoracotomy

A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.
Acinetobacter baumannii ; Bronchial Fistula ; Carbon Dioxide ; Carbon ; Chest Tubes ; Empyema ; Fistula ; Humans ; Hydropneumothorax ; Hypercapnia ; Lung ; Lung Neoplasms ; Respiration, Artificial ; Respiratory Insufficiency ; Thoracotomy

OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND 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/microL). 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. CONCLUSION: 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.
Aged ; Aged, 80 and over ; Female ; Fistula/complications ; Humans ; Hydropneumothorax/complications/microbiology/*radiography ; Lung/radiography ; Male ; Middle Aged ; Mycobacterium avium/*isolation & purification ; Mycobacterium avium Complex/isolation & purification ; Mycobacterium avium-intracellulare Infection/*diagnosis/microbiology ; Pleural Diseases/complications/microbiology/*radiography ; Pleural Effusion/complications ; Retrospective Studies ; *Tomography, X-Ray Computed

Migration of wires or pins around the shoulder is a known complication, though their migration within the chest is uncommon. We report an unusual case of hydropneumothorax due to migration of a bent Kirschner wire from the right proximal humerus in a 63 year-old man. We reviewed his clinical history, physical examination, imaging findings, surgical method and outcome. We also reviewed the literature on orthopaedic wire migration and latest technique in removal of the wires. Chest radiographs and chest computerized tomography are useful in detection and diagnosis of this disorder. Regular radiographic follow-up is needed for patients with internal fixation devices; any fractured or migrated pins or wires must be removed immediately to prevent dangerous complications. It is always important to remove the wires at the end of the treatment. Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.
Bone Wires ; adverse effects ; Foreign-Body Migration ; complications ; Humans ; Humeral Fractures ; surgery ; Hydropneumothorax ; etiology ; Male ; Middle Aged ; Tomography, X-Ray Computed

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to confirm the correct position of feeding tubes. Chest X-ray is the gold standard to detect tracheal malpositioning of the feeding tube. We present three cases in which intubated patients exhibited an altered mental state. An assistant guide wire was used at the insertion of small-bore feeding tubes. These conditions are thought to be potential risk factors for tracheobronchial malpositioning of feeding tubes.
Critical Care ; Critical Illness* ; Enteral Nutrition ; Fistula ; Humans ; Hydropneumothorax ; Mortality ; Nose ; Pharynx ; Pneumonia ; Pneumothorax ; Respiratory System ; Risk Factors ; Stomach ; Thorax ; Ulcer

Boerhaave syndrome is a rare and life-threatening disease that often presents a diagnostic challenge. It is usually confused with critical but more prevalent diseases such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Boerhaave syndrome is caused by forceful vomiting resulting in a full-thickness tear of the middle or lower esophagus, typically an area of natural narrowing and at the esophagogastric junction and the left atrium. Because of these anatomic sites, hydropneumothorax, hemopneumothorax and pneumopericardium can occur. We report a case of a 48-year-old chronic alcoholic man presenting with abrupt onset of massive bilateral hydropneumothorax. In this case, it was hard to take a medical history from the patient due to sudden respiratory arrest when he arrived at the emergency room. Despite ongoing chest tube drainage, hydropneumothorax didn't improve. Pleural fluid amylase level was increased. Because of the possibility of esophageal rupture, esophagography was performed. As a result of the esophagography, he was diagnosed as Boerhaave syndrome with penumopericardium. If massive hydropneumothorax of unknown cause presents abruptly, boerhaave syndrome should be suspected as one of its causes. We recommend that pleural fluid amylase levels to be checked and if it is elevated, esophagography should be performed immediately.
Alcoholics ; Alcoholism ; Amylases ; Chest Tubes ; Drainage ; Emergencies ; Esophageal Perforation ; Esophagogastric Junction ; Esophagus ; Heart Atria ; Hemopneumothorax ; Humans ; Hydropneumothorax ; Mediastinal Diseases ; Middle Aged ; Myocardial Infarction ; Pancreatitis ; Peptic Ulcer ; Pneumopericardium ; Rupture ; Vomiting

OBJECTIVE: To investigate the serial CT findings of Paragonimus westermani infected dogs and the microscopic structures of the worm cysts using Micro-CT. MATERIALS AND METHODS: This study was approved by the committee on animal research at our institution. Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until six months for determining the radiologic-pathologic correlation. Three dogs (one dog each time) were sacrificed at 1, 3 and 6 months, respectively. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for examining the worm cysts. RESULTS: The initial findings were pleural effusion and/or subpleural ground-glass opacities or linear opacities at day 10. At day 30, subpleural and peribronchial nodules appeared with hydropneumothorax and abdominal or chest wall air bubbles. Cavitary change and bronchial dilatation began to be seen on CT scan at day 30 and this was mostly seen together with mediastinal lymphadenopathy at day 60. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, the migratory features of the subpleural or peribronchial nodules were seen on all the serial CT scans. Micro-CT showed that the cyst wall contained dilated interconnected tubular structures, which had communications with the cavity and the adjacent distal bronchus. CONCLUSION: The CT findings of paragonimiasis depend on the migratory stage of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and the adjacent distal bronchus.
Animals ; Contrast Media/administration & dosage ; Cysts/*parasitology/*radiography ; Disease Progression ; Dogs ; Female ; Follow-Up Studies ; Hydropneumothorax/parasitology ; Iohexol/analogs & derivatives/diagnostic use ; Lung/parasitology/radiography ; Male ; Observer Variation ; Paragonimiasis/*diagnosis/parasitology ; Paragonimus westermani/growth & development/isolation & purification ; Pleural Effusion/parasitology ; Radiographic Image Enhancement/methods ; Time Factors ; Tomography, X-Ray Computed/*methods

We report two cases of parenchymal air-fluid level in emphysematous lungs. Plain chest radiograph showedpneumonic consolidation with an air-fluid level. HRCT in the supine position showed intrapulmonary fluidcollection with an air-fluid level, which moved to the dependent portion when the patient was in the proneposition. When pneumonia developed in severe emphysematous lungs, a movable parenchymal air-fluid level can bevisualized, though the presence of this on plain chest radiographs cannot be interpretated as hydropneumothorax.
Humans ; Hydropneumothorax ; Lung* ; Pneumonia ; Pulmonary Emphysema ; Radiography, Thoracic ; Supine Position

Closed thoracostomy with UWSD* which is the most utilized procedure in chest surgery applies general thoracic disorders, trauma and after-thoracic surgery. The University hospital was involved on operating 2341 cases of closed thoracostomy with UWSD except chest tubing after-thoracic surgery for a full six years from January, 1991 to December, 1996. The rate of men and women out of the total 2341 cases was 3.5 : 1, the distribution by age showed that men were 36.6+/-21.0 years old, women were 47.0+/-20.2 years old and so that the total were 40.0+/-20.5 years old. As for indication, spontaneous, secondary and traumatic pneumothorax were the most common, in addition to hemothorax, hemopneumothorax, hydrothorax, hydropneumothorax, empyema, chylothorax. The most indwelling period of chest tubing is between eight and fourteen days for 974 cases and the average is 13.7+/-6.3 days, The average drainage amount immediately after thoracostomy was 537+/-88ml, and in 694 cases(46.0%), the drain amount was 201~500 ml. The rate of right and left tubing was 52.4 : 47.6, in 2071 cases(88.5%), the thoracostomy was the first chance and 2210 cases(94.4%) were treated with a single tube drainage. Almost all the patients complained of tube site pain, besides tube site infection, intercostal neuralgia, loss of tube function by the pleural adhesion, intrathoracic infection, incomplete reexpansion of defective lung, hemorrhage caused by the rupture of a blood vessel, subcutaneous emphysema, lung parenchymal rupture, diaphragmatic and intraabdominal trauma, reexpansionary pulmonary edema of one side lung and cellulitis were relapsed. 84.6% of all patients recovered with only closed thoracostomy and the rest of patient needed additional some necessary managements and so on to have successful results. There were two deaths(0.1%), caused by reexpansionary pulmonary edema, the cellulitis were complicated by thoracostomy with UWSD on an empyema patients to come to death(due to sepsis). * UWSD = under water seal drainage.
Blood Vessels ; Cellulitis ; Chylothorax ; Drainage ; Empyema ; Female ; Hemopneumothorax ; Hemorrhage ; Hemothorax ; Humans ; Hydropneumothorax ; Hydrothorax ; Lung ; Male ; Neuralgia ; Pneumothorax ; Pulmonary Edema ; Rupture ; Subcutaneous Emphysema ; Thoracostomy* ; Thorax

The lung nodule is one of the pleuropulmonary menifestations in rheumatoid arthritis. We report here a case exhibiting hydropneumothorax due to a bronchoplerual fistula resulting from a ruptured rheumatoid lung nodule complicated with a aspergilloma in it. A 39 year-old man with rheumatoid arthritis was admitted because of cough for one month. Multiple subcutaneous nodules were noted and multiple lung nodules were seen on chest X-ray, Peripheral white cells were 9,600/mm3 with 1896 of eosinophils. The percutaneous needle aspiration biopsy of the largest lung nodule of right upper lobe showed massive necrosis without acid fast bacillus, fungus, or malignant cell. Three months after discharge, air-meniscus sign was seen on the biopsied lung nodule on X-ray. Five months later, the patient was readmitted due to dyspnea and chest pain and simple chest X-ray showed hydropneumothorax on the right side. The pneumothorax was not healed after closed thoracotomy and tube drainage, and high fever developed. The pleural fluid culture revealed Pseudomonas aeroginosa and Aspergillus fumigatus. Seventy days after admission, exploratory thoracotomy was done. Aspergilloma was found in the cavitated lung nodule which was ruptured into the pleural cavity through bronchopleural fistula.
Adult ; Arthritis, Rheumatoid* ; Aspergillus fumigatus ; Bacillus ; Biopsy, Needle ; Chest Pain ; Cough ; Drainage ; Dyspnea ; Eosinophilia* ; Eosinophils ; Fever ; Fistula* ; Fungi ; Humans ; Hydropneumothorax ; Lung* ; Necrosis ; Needles ; Pleural Cavity ; Pneumothorax ; Pseudomonas ; Thoracotomy ; Thorax