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Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

Christopher Ull, Mirko Aach, Josef Reichert, Thomas Armin Schildhauer, Justyna Swol
  • Christopher Ull
    BG University Hospital Bergmannsheil, Department of General and Trauma Surgery, Germany
  • Mirko Aach
    BG University Hospital Bergmannsheil, Department of Spinal Cord Injuries, Germany
  • Josef Reichert
    BG University Hospital Bergmannsheil, Department of Cardiothoracic Surgery, Germany
  • Thomas Armin Schildhauer
    BG University Hospital Bergmannsheil, Department of General and Trauma Surgery, Germany

Abstract

Pulmonary infections are life-threatening complications in patients with spinal cord injuries. In particular, paraplegic patients are at risk if they are ventilator-dependent. This case history refers to a spinal cord injury with a complete sensorimotor tetraplegia below C2 caused by a septic scattering of an intraspinal empyema at C2-C5 and T3-T4. A right-sided purulent pneumonia led to a complex lung infection with the formation of a pleuroparenchymal fistula. The manuscript describes successful, considerate, non-surgical management with shortterm separate lung ventilation. Treatment aimed to achieve the best possible result without additional harm. A variety of surgical and conservative strategies for the treatment of pleuroparenchymal fistula (PPF) have been described with different degrees of success. We detail the non-surgical management of a persistent PPF with temporary separate lung ventilation (SLV) via a double-lumen tube (DLT) in combination with talc pleurodesis as an approach in patients who are unable to undergo surgical treatment.

Keywords

spinal abscesses, paraplegia, pleuroparenchymal fistula, talc pleurodesis, double-lumen tube ventilation

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Submitted: 2017-10-08 12:48:12
Published: 2018-01-29 12:02:39
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Copyright (c) 2018 Christopher Ull, Mirko Aach, Josef Reichert, Thomas Armin Schildhauer, Justyna Swol

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