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Vol.58 No.1 contents | Japanese/English |
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- Case Report -
A Case of Lung Squamous Cell Carcinoma with Pyopneumothorax Treated with Autologous Blood and Fibrin Sheet Using Medical Thoracoscopy
Yusuke Tanaka1,2, Mamoru Takahashi1, Midori Hashimoto2, Yasuhito Honda3, Gen Yamada1, Hiroki Takahashi11Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Japan, 2Department of Respirology, NTT East Corporation Sapporo Hospital, Japan, 3Sapporo Nishi Kojinkai Clinic, Japan
Background. Generally, drainage with antimicrobial treatment may be insufficient to treat pyopneumothorax with a fistula. Case. An 82-year-old man with a cavitary tumor was examined. Chest computed tomography (CT) showed that the tumor was located in the left lower lobe S6 and was 60 mm in diameter. The patient underwent a transbronchial biopsy resulting in a diagnosis of lung squamous cell carcinoma (cT2bN0M0, stage IIA). Because he rejected intensive care for lung cancer, he received supportive care. During the follow-up period, he became complicated with bacterial pneumonia, and the tumor developed pyopneumothorax with a bronchopleural fistula. Although the fistula was estimated to be 10 mm in diameter by CT, a fistula closure operation was thought to be risky, due to the patient's poor systemic condition. Therefore, we planned to close the fistula using medical thoracoscopy under local anesthesia. Under a thoracoscopic view, we broke and removed the fibrin network as much as possible using forceps. Next, we pumped autologous blood into the cavity through the fistula and then covered the fistula with a fibrin sheet. The left pneumothorax was improved. After the pneumonia was improved by anti-bacterial treatment, the patient was able to leave our hospital, albeit only for a short period. Conclusion. This method seems to be relatively effective for treating pyopneumothorax with a fistula when the patient cannot undergo surgical treatment due to poor systemic condition.
key words: Medical thoracoscopy, Pyopneumothorax with fistula, Autologous blood patch
Received: November 3, 2017
Accepted: December 7, 2017
JJLC 58 (1): 41-45, 2018
