Bronchopleural fistula (BPF) is a serious complication after lobectomy with an incidence of 1.5–28%[1]. BPF can lead to hydropneumothorax, severe pneumonia, and even multiple organ failure, which are associated with a mortality of up to 70%[1]. We report a case of a 27-year-old adopted man who was diagnosed with BPF, and was treated by implantation of thoracic drainage catheter based on interventional technique for continuous negative pressure drainage (CNPD). He was undergone thoracoscopic right lower lobectomy 60 days ago because “mild chronic inflammation (postoperative pathological findings)”. On the 37th postoperative day, he experienced sudden cough, chest tightness, and shortness of breath. CT showed right massive pneumothorax and a small amount of pleural effusion. A closed thoracic drainage (CTD) tube was implanted. The symptoms were not relieved. On the 50th postoperative day, chest CT showed that the hydropneumothorax had increased, 90% compression of the right lung (Fig. 1). Fiberoptic bronchoscopy revealed a small fistula in the bronchial stump.
He was transferred to our department. Under the guidance of Dyna CT, the upper edge of the 5th rib at the front of the right axilla was identified as the puncture point. An 8.5F external drainage catheter was implanted. Under fluoroscopy, the head end of the catheter was adjusted above the diaphragm in the chest. The original CTD tube was replaced with a 12F external drainage catheter. The two drainage catheters were externally connected under central negative pressure. The negative pressure was maintained between 150 and 300 mmHg for 24h every day, and 100–130 ml of purulent liquid was drawn every day. Chest tightness, shortness of breath, and cough were significantly reduced to disappear within 3 days of CNPD. One week later, CT showed that the hydropneumothorax was reduced. Under fluoroscopic guidance, the 8.5F external drainage catheter was replaced with a 10.2F one (Fig. 2). The patient was hospitalized for 7 days. After discharge, the patient used a portable negative pressure suction device at home to maintain CNPD.
One month later, CT showed that the hydropneumothorax had disappeared, and the lung had completely re-expanded (Fig. 3). Fluoroscopy showed that the residual cavity had almost disappeared through drainage catheter angiography (Fig. 2B). The catheters were pulled out by 2 cm every day until the side hole of the catheters were exposed outside the skin, after which it was completely pulled out and bandaged. Repeat chest CT performed 1 week later showed that the lungs were fully inflated and the residual cavity was healed.