Patient refer to clinic with a Fistula in left Hemithorax

بڵاوکردنەوە:

ڕاستی عبداللە ڕەزا

نووسەر:

د. سەباح حوسنی

بینراو:

240

بەش:

زانست

(PATIENT PRESENTATION)

Patient refer for evaluation by surgeon: -

Patient was male. He was 62 years old.

He had a fistula in left sided of Hemi Thorax with purulent discharge that He should change its bandage three Times a day.

He had not fever and chill, and He had loss of appetite and Weight loss.

He had not hemoptysis a cough and sputum.

 

(PAST MEDICAL HISTORY)

He was Exsmoker.

He had 30 pack years smoking history.

He had history of pulmonary Tuberculosis disease seventeen years ago.

He was gotten tuberculosis drugs six months and He had negative sputum culture at the end of treatment.

He was history of upper Endoscopy because of Upper GI Bleeding three years ago.

Then He was Admitted to Hospital with Massive Hemoptysis.

 

● He was undergone more and Antibiotic therapy but patient had continuous purulent discharge.

● He usually was taken quinolone.

 

● Left lower lobe. Flixibe Bronchoscopy was done for Him. He had massive bleeding from left lower lobe.

● Patient refer to thoracic surgery unit. He was undergone emergent surgery.

● Left lower lobectomy was done.

● He was discharged without symptom.

● Patient had continuous purulent discharge through thoracic unhealing fistula.

● He refers to Infectious disease Specialist.

 

(PHYSICAL EXAMINATION)

● He is cachectic. He has BiTemporal Atrophy.

● BP:120/80mmhg, PR:70, TR:37.2©, RR:18

● ORAL CAVITY NL

● NECK NL

● CHEST 

● A FISTULA was seen in lower portion Anterior Axillary line.

● TACTILE FERMITUS and VOCAL FERIMITUS was decreased in lower anterior left hemi thorax and posterior left Hemi thorax.

 

(ETIOLOGY)

● lung resection surgery.

● (pneumonectomy, lobectomy, segmentectomy), with a frequency ranging from 4.5 to 20 percent after pneumonectomy and…

● 0.5 to 1 percent after lobectomy.

 

Thoracic Fistula Differential diagnosis

● infection Most patients present in the first two weeks early (<14 days).

● late postoperative period (>14 days).

 

● Tuberculosis.

● Non tuberculosis mycobacterium.

● Bacterial infection.

● Malignancy.

 

(RISK FACTORS)

● Right-sided surgery

● Pneumonectomy

● Chemotherapy and radiation therapy

● Diabetes mellitus

● Heavy smoking and chronic obstructive pulmonary disease

● Low nutritional status or poor wound healing

● Previous ipsilateral thoracotomy

● Residual tumor at the bronchial margin

● A large diameter bronchial stump (>25 mm)

● Extensive lymph node dissection

● Older age (>60 years)

● Prolonged postoperative mechanical ventilation

 

(THORACIC FISTULA DIFFRENTIAL DIAGNOSIS)

● infection Most patients present in the first two weeks early (<14 days).

● late postoperative period (>14 days).

● Tuberculosis

● Non tuberculosis mycobacterium

● Bacterial infection

● Malignancy

 

(DIAGNOSTIC EVALUATION)

● Clinical,

● Radiographic

● Bronchoscopic findings

 

 

* The image of (Spiral Lung CT Scan)