minocycline and Pleural-Diseases

Topics: Bronchial Fistula; Humans; Male; Minocycline; Pleural Diseases; Pleurodesis

For decades, chemical pleurodesis using minocycline has been widely accepted as an effective, safe, and cheap treatment for persistent air leak after pulmonary resection. We report a case with persistent postoperative air leak that suffered from cardiorespiratory arrest just after a minocycline pleurodesis, which may be related to the aspiration of minocycline solution from a bronchopleural fistula. Therefore, we suggest a bronchoscopic examination be performed before the pleurodesis if a bronchopleural fistula is highly suspected.

Topics: Aged; Anti-Bacterial Agents; Bronchi; Bronchial Fistula; Bronchoscopy; Diagnosis, Differential; Fistula; Follow-Up Studies; Humans; Male; Minocycline; Pleural Diseases; Pleurodesis; Pneumonectomy; Tomography, X-Ray Computed

We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (Picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.

Topics: Bronchial Fistula; Bronchoalveolar Lavage; Embolization, Therapeutic; Empyema, Pleural; Female; Fistula; Humans; Middle Aged; Minocycline; Picibanil; Pleural Diseases; Postoperative Complications; Tomography, X-Ray Computed