Medicine in images
Open thoracostomy as treatment of chronic empyema with bronchopleural fistula
Toracostomía abierta como tratamiento de un empiema crónico con fístula broncopleural
M.N. Solís-Marquínez
, J.F. López-Caleya
Corresponding author
Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón (Asturias), Spain
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Solís-Marquínez, J.F. López-Caleya" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M.N." "apellidos" => "Solís-Marquínez" "email" => array:1 [ 0 => "natayasolis@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.F." "apellidos" => "López-Caleya" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón (Asturias), Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Toracostomía abierta como tratamiento de un empiema crónico con fístula broncopleural" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2077 "Ancho" => 2500 "Tamanyo" => 546253 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 77-year-old man with a history of chronic obstructive pulmonary disease, pneumoconiosis and pulmonary tuberculosis as a youth, which were treated with left collapse therapy, leaving behind a destroyed lung and residual productive pleurisy. The patient consulted for dyspnea, bronchorrhea and fever. The chest radiography revealed a left pleural effusion with an air-fluid level (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A, arrow) and a right pneumonic condensation. The chest computed tomography showed a bronchopleural fistula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B, arrow) with opacification of the postuberculous residual cavity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B, asterisk). The pleural fluid was purulent, with negative results for the microbiological studies for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> and other germs. Despite antibiotic treatment with amoxicillin-clavulanate for 4 weeks and with piperacillin-tazobactam for 3 more weeks, the fever, bronchorrhea and general deterioration persisted. Radiologically, the only change was the disappearance of the right condensation. A permanent open thoracostomy was therefore performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) to evacuate, with progressive closure as a second intent. In <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D, we can see the exposed lung with air bubbles, which shows the persistence of the bronchopleural fistula. No intrapleural therapy or vacuum-assisted closure was performed. The patient experienced a postoperative complication and died a month later.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-22" "fechaAceptado" => "2017-08-10" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Solís-Marquínez M, López-Caleya JF. Toracostomía abierta como tratamiento de un empiema crónico con fístula broncopleural. Rev Clin Esp. 2018;218:38–39.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2077 "Ancho" => 2500 "Tamanyo" => 546253 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021800000001/v1_201801040959/S2254887417301200/v1_201801040959/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000001/v1_201801040959/S2254887417301200/v1_201801040959/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301200?idApp=WRCEE" ]
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