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Trichomonas sp. was found in a patient with empyema and chronic obstructive pulmonary disease. This is a uncommon finding. A wet mount of pleural fluid is recommended to be observed by light microscopy.

An intravenous drug user presented with bacteraemia and massive hemoptysis 10 years after a penetrating cardiac injury. He was found to have false left ventricular aneurysm with ventriculo-bronchial fistula. The clinical course suggests that the aneurysm became infected and that the inflammatory process weakened the aneurysmal sac and led to the development of fistula. Prompt recognition of the aneurysm with appropriate surgical repair resulted in a successful outcome.

Conclusions: Bronchobiliary fistula is an in frequent manifestation of common bile duct obstruction. The slowly progressive narrowing of the common duct by the fibrosis of chronic pancreatitis is an even more rare mechanism of such fistula formation with only two cases having been reported previously. A third case of bronchobiliary fistula caused by chronic pancreatitis is presented and its successful management is discussed., Background: A 54-yr-old male with known chronic pancreatitis presented with a cough productive of copious amounts of bile and with pulmonary infiltrates., Methods: Diagnosis of bronchobiliary fistula was made based on HIDA scan and confirmed by operative cholangiogram., Results: Successful correction of this fistula was accomplished by operative closure of the fistulous tract and diversion of the narrowed bile duct by hepaticojejunal bypass.

Aortobronchial fistulas are an uncommon and serious cause of hemoptysis. We present three cases of aortobronchial fistulas that were diagnosed and treated at our hospital. They were presented as massive hemoptysis. The clinical suspicion of a leaking thoracic aortic aneurysm into the bronchial tree should prompt the correct diagnostic procedures since early surgery is the only way to manage this condition.

Levels of endothelin (ET)-1 peptide are transiently increased after major physical stress. While studying sequential changes in plasma ET-1 levels during various types of stress, we noticed that the level of plasma ET-1 began to rise 10 days post-operatively in one patient with lung cancer who had undergone a left lower lobectomy. 35 days postoperatively a bronchopleural fistula became clinically manifest. The case is presented and the use of plasma ET-1 as an indicator is discussed.

There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.

Background: Congenital bronchoesophageal fistulas have rarely been reported. Presented here is the 14-year experience of our hospital with this lesion., Methods: The study comprises 13 patients; 9 had a Braimbridge type II fistula; 2, a type I fistula; and 2, a type IV fistula. The most frequent site of communication was between the middle esophagus and the right lower lobe of the lung, especially the superior segment. A fistulectomy, with or without pulmonary resection, was performed on each patient., Results: All patients had complete relief of symptoms. No operative complications were observed., Conclusions: Congenital bronchoesophageal fistulas in adults are usually diagnosed by an esophagography. Symptoms are often nonspecific, and the possibility of a congenital bronchoesophageal fistula should be considered in patients who complain of long-standing unexplainable respiratory symptoms such as coughing and frequent pulmonary infections. The surgical intervention is relatively simple. In many cases, a fistulectomy with simple closure of the openings in both the esophagus and the bronchus is all that is required. Pulmonary resection is needed in some patients with severe bronchiectasis and recurrent pneumonitis.

To our knowledge, this is the first case report of a broncho-splenic fistula of hydatid origin. We discuss the clinical, radiological and therapeutic aspects of this rare complication of hydatid disease.

Ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings of a patient suffering from an amebic abscess of the liver complicated by a bronchohepatic fistula are presented. Subsequent to US, CT provided the specific diagnosis. Multiplanar MRI was valuable to directly visualize the secondary diaphragmatic rupture and the bronchohepatic fistula.

Bronchoesophageal fistulas (BEF) in an adult, whether acquired or congenital, are uncommon but bronchoesophageal perforation secondary to broncholithiasis caused by calcified mediastinal adenopathy and leading to the formation of a fistulous tract is extremely rare. We present a case of acquired BEF in a 57-years-old women who presented cough with expectoration of broncholiths, hemoptysis and cough after swallowing liquid or solid hemoptysis and cough after swallowing liquid or solid foods. The chest film and computed tomographic scan showed calcified mediastinal adenopathy. Endoscopic examination of the esophagus revealed no mucosal abnormality. A bronchial esophageal fistula was identified at the level of the 1/3 midesophagus just below the carina in the esophagogram. The bronchoscopy showed a polypoid area located in the medial side of the right main bronchus. There was no evidence of neoplasm. The patient underwent excision of fistula and interposition of pleural bundle after completing a right posterolateral thoracotomy. The postoperative course was uneventful and the patient has been doing well on follow-up.

Twenty six patients with esophagotracheal fistula or esophagobronchial fistula were treated from 1960 to 1991. There were 18 males and 8 females with age ranging from 19 to 69. Trauma and complication of esophageal diverticulum were the main causes of fistula. Among 23 patients surgically treated, 10 underwent direct repair, and 13 either closure of esophageal defect or tracheal or bronchial defect. The concomitant procedures were permanent tracheostomy, tracheal resection and reconstruction, pulmonary resection, thoracoplasty esophagectomy, and esophagogastric anastomosis. All patients resumed normal eating. Complications included paralysis of recurrent nerves, empyema, injury and ligation of subclavian artery, dehiscence of tracheal anastomosis, and contralateral pneumohydrothorax in each patient. Prognosis of 3 nonsurgical treatments of fistulas was poor. Surgical intervention should be done as soon as the diagnosis is established in order to minimize pulmonary complication.

A 76-year-old white woman with ovarian adenocarcinoma developed massive biliptysis following an unexpected respiratory arrest. The possibility of active right upper quadrant disease had not been entertained until she developed this complication of a biliobronchial fistula. Because this sign had not previously been observed by any of us, it led to a comprehensive review of the topic of biliobronchial fistula.

We present three preterm infants with pulmonary complications due to central venous silicone catheters malpositioned in the left or right pulmonary artery. One infant developed an arterial-bronchial fistula. The other two infants had pneumonitis without evidence of vessel perforation. The course of these complications was good after the catheter was withdrawn into the superior vena cava.

Enterobronchial fistulas are extremely rare. Herein we describe a 69-year-old man who had previously undergone resection of a gastric adenocarcinoma. He was hospitalized because of a fever, cough that produced brown sputum, dyspnea at rest, and an 18-kg weight loss during the previous year. A jejunobronchial fistula was diagnosed when methylene blue, which had been added to an enteric feeding, was detected in a bronchus during bronchoscopy. In addition to the current case, we include a brief review of the literature.

We describe a 56-year-old man with the new onset of hemoptysis, increasing in frequency and magnitude, initially diagnosed and treated as pulmonary embolism. Bronchoscopy, computed tomography, and thoracic aortography were performed twice before the diagnosis was made. Thirteen years previously, the patient underwent thoracic aortic interposition graft placement for aortic laceration as a result of a motor vehicle accident. The second aortogram demonstrated a small pseudoaneurysm at the expected proximal graft suture line. Aortobronchial fistula, a rare cause of hemoptysis, was diagnosed. The patient underwent successful resection of the graft and placement of a new dacron interposition graft. All cultures, including blood, sputum, and operative specimen cultures, were negative. The patient is alive and well 1 year following surgery.

A 52-year-old man had been having cough on drinking water since 30 years. He coughed out blood 20 years ago. Chest roentgenogram showed the infiltrating shadow in the right lower lung field and the left hilum. Chest computed tomogram in the left atrium level showed fistulous communication between the bronchus and the esophagus and cavity lesion. Esophagogram showed fistulous communication between the bronchus (rt. B7) and the middle third of the esophagus. Bronchogram showed the stenotic lesion of the right B7a and B*. And abnormal bronchus was revealed and fistula was suspected. The orifice of the fistula was seen by esophageal endoscopy. Through the right posterolateral thoracotomy, fistelectomy and covering with pleural flap over the esophageal suturing site were performed. Histologic finding of the resected specimen revealed fistula's wall composing of smooth muscle lined with squamous cell layer. This case is categorized as Braimbridge type II. The postoperative course was uneventful and the patient is now in free of complaints at the 6th month's P.O.D.

The management of postpneumonectomy bronchopleural fistulae continues to constitute a major therapeutic challenge. Refinements of surgical techniques have reduced the incidence of this dreaded complication although it cannot be totally prevented. Management remains controversial. We report our recent experience of three patients with bronchopleural fistulae following a right pneumonectomy, two for bronchogenic carcinoma and another for non-tuberculous, suppurative lung disease. Our treatment of choice for these patients is, immediate pleural drainage together with parenteral broad spectrum antibiotics followed by endoscopic closure of the fistula with monomeric n-butyl-2-cyanoacrylate glue (Histoacryl blue, B Braun, Melsungen, Germany). The pleural space is then irrigated with Povidone Iodine to sterility following which the closed bronchial stump is reinforced following which the closed bronchial stump is reinforced and the pleural space obliterated by decortication, omentopexy and by a tailored thoracoplasty. This cosmetically acceptable treatment produces minimal functional disability and is achieved with minimal morbidity and mortality in these critically ill patients.

The case of a 52-year-old woman with an oesophagobronchial fistula is presented. The diagnosis was not made preoperatively. The patient was operated twice, with resection of a diverticulum of the oesophagus at the last operation. The congenital or acquired origin of the fistula is discussed.

A young male patient from Somalia presented with a productive cough since a few days, and he complained about vomiting after meals and a rapid loss of weight of 20 kg. Endoscopic, radiological and clinical examinations revealed a broncho-esophageal fistula. Further examinations showed mycobacterium tuberculosis as the underlying cause of the disease; a malignancy was excluded. Antituberculous treatment resulted in the loss of the present symptoms as well as in a clinical and endoscopic closure of the fistula.

A 12-year-old boy was admitted to hospital for abdominal pain, vomiting and fever. On physical examination he had râles on the lower right hemithorax without any respiratory complaints. Chest X-ray revealed a condensation in the right lower chest. Abdominal findings were secondary to lobar pneumonia. Treatment of pneumonia with antibiotics showed no improvement over 2 days. On bronchoscopy no foreign body was seen, but pus was aspirated. Two days later a mass appeared on the right hemithorax and fistulized. An organic foreign body, Hordeum murinum, with 3-5 ml of pus was observed. Chest X-ray taken at the day of fistulization showed no pneumothorax or subcutaneous emphysema. Less than 11 cases of pneumocutaneous fistulas secondary to aspiration of grasses have been reported in literature. Why an ear of Hordeum murinum can migrate only in a forward direction and why a pneumothorax had not developed is discussed.

A case of a 48 year old woman presenting with bilioptysis due to a cholecystobronchocolic fistula is reported. Bilioptysis is a rare complication of biliary fistulae, with a high mortality due to chemical pneumonitis. Bronchospasm and rapid respiratory failure may ensue if aggressive management is not adopted. The site of fistulation is established by cholangiography, preferably by the percutaneous transhepatic route. Continued biliary drainage can lead to closure of these fistulae, or allow sufficient improvement in clinical condition to allow definitive surgery to be performed electively.

Bronchopleural fistula occurring as a complication in patients with the adult respiratory distress syndrome typically appears after 1 to 2 wks of illness, and is associated with a poor prognosis. Whether the bronchopleural fistula per se worsens outcome is not known because of the lack of studies on its natural history. There are several potential adverse effects of bronchopleural fistula in adult respiratory distress syndrome (e.g., incomplete lung expansion, loss of effective tidal volume or positive end-expiratory pressure, inability to remove CO2, etc.), but the actual frequency of these problems among patients with this complication appears to be low, and their magnitude and clinical impact remain uncertain. Most of the literature consists of anecdotal reports of innovative measures for reducing the leak, such as manipulation of chest tube suction, high-frequency jet ventilation, independent lung ventilation, and various maneuvers using the fiberoptic bronchoscope. Controlled studies are lacking, however, and the application of sound, general management principles is of primary importance. The great majority of patients can be managed satisfactorily without resort to unfamiliar, labor-intensive, potentially hazardous measures.

Congenital oesophageal respiratory tract fistula presenting in adult life is rare. A tracheo-oesophageal and a broncho-oesophageal fistula presenting in a 22 year old female and 68 year male, respectively, are described. In both, symptoms of chronic recurrent pulmonary suppuration were initially attributed to alternative aetiologies, resulting in diagnostic delay and inappropriate management. Correct diagnosis was established by flexible bronchoscopy and oesophageal contrast studies. Surgical division of fistulae resulted in complete symptom resolution.

Benign esophago-respiratory fistula is a relatively rare condition of great surgical interest because of its potential total curability. The ratio of benign to malignant fistula is around 1:5. Sometimes the diagnosis is difficult because of the non specific nature of presenting symptoms. This report concern 10 cases of benign esophagorespiratory fistulas observed during a period of twenty years. There were 6 esophago-tracheal fistulas and 4 esophagobronchial fistulas. In 4 cases the fistulas were congenital, in 1 the fistula was due to perforation of esophageal diverticulum and in 3 patient the fistula developed after prolonged intubation. All patient underwent surgical treatment consisted of division of the fistula and suture of both esophageal and respiratory defect. In 4 cases we performed pulmonary parenchyma resection because of irreversible inflammatory lesions. There were no perioperative death. One young patients with tubercular fistula developed a dehiscence of esophageal suture successfully treated with pleural drainage and several application of fibrin glue. All patient were considered to have very good results.

We present three children with congenital bronchobiliary fistula (CBBF). The first infant underwent resection of the fistula at age 3 weeks and was reported as a success. She returned 7 years later with bilious expectoration for which a second thoracotomy was performed. One year thereafter a bile collection in the right chest required open drainage. Subsequently, the left hepatic lobe was resected. The second child was initially diagnosed as suffering from gastroesophageal reflux. He underwent a fundoplication and a gastrostomy at age 9 months. Persistence of bilious sputum led to the diagnosis of CBBF at age 23 months. The fistula was excised through a right thoracotomy. The distal end was injected demonstrating an arborization involving the entire left hepatic lobe. Since there was no communication with the remaining biliary tree or the intestine, a left hepatectomy was performed. The third child was reported in a communication focusing on the diagnosis of CBBF by hepatobiliary scintigraphy. Her history is almost identical to the second patient. However, instead of a hepatectomy, she underwent a Roux-en-Y drainage of the fistula. The three children had uneventful recoveries and are well. We believe that an abnormal biliary tract should be studied by contrast injection. If no decompressing communication with the normal biliary ducts or the duodenum can be demonstrated, the involved hepatic segment should be resected or internally drained. Children who underwent simple fistula excision must have close long-term follow-up.

A case of aortobronchial fistula occurring 13 years after coarctation repair by patch aortoplasty is presented. Correct diagnosis was established by computed tomographic scanning and magnetic resonance imaging. Surgical treatment consisted of simple closure of the bronchial defect and interposition of a Dacron graft under partial extracorporeal bypass.

A case of congenital bronchoesophageal fistula in a 9-month-old infant is presented. He had had repeated pulmonary infections since he was 2 months old. A barium swallow examination showed a communicating fistula between the mid-esophagus and the posterior segmental bronchus of the right upper lobe. MRI clearly demonstrated the course of the fistula.

Pathogenesis, diagnosis and treatment of non-malignant esophago-bronchial fistulas is discussed. A case report of a 60 year old woman with such a disorder is presented. Surgical treatment completely cured this patient.

The case of a senile dementia patient 86 year old, and a supposed clinical history of swallowing a foreign body is presented. After a clinical study (esophagogram, flexible and rigid esophagoscopy and bronchoscopy) and finally the autopsy of the patient, we found and idiopathic esophago-bronchial fistula.

The authors report the case of a man aged 70 who was admitted to hospital for staphylococcal pulmonary suppuration which occurred during the long-term follow-up for an osteosynthesis for a fractured humerus. The diagnosis of a pulmonary abscess in contiguity with a staphylococcal spondylodiscitis was only established by computed tomographic examination and the aspiration from a vertebral body. The outcome was fatal, despite appropriate antibiotic treatment, on account of the past medical history of the patient. The diagnosis might have been made by the presence of osseous sequestra in the bronchial secretions, the bronchial fistulae in contiguity with the vertebral column was confirmed at autopsy.

Carcinoma of the hepatic duct bifurcation was diagnosed in a 67-year-old women with obstructive jaundice. As metastatic spread could not be demonstrated the carcinoma was removed with a view of achieving a cure (hemihepatectomy, resection of the hepatic duct and the bifurcation, cholecystectomy and hepatojejunostomy). Histological examination indicated adenocarcinoma of the biliary tract. Seven months postoperatively the patient was found to be cachectic and cough up greenish liquid sputum. Bilirubin concentration in sputum was 500 mumol/l. There was no jaundice and total bilirubin concentration was 33 mumol/l. Alkaline phosphatase was 508 U/l, but GOT and GPT were normal (23 U/l and 21 U/l). Computed tomography confirmed the clinical diagnosis of a biliobronchial fistula. The patient died 9 days after renewed hospitalization of tumour cachexia. The biliobronchial fistula was found at necropsy.

A 56-year-old man with metastatic prostatic carcinoma underwent placement of a Hickman catheter. Approximately two months after the procedure, he was admitted to the hospital with hemoptysis and in respiratory distress. A contrast computed tomographic (CT) scan confirmed the diagnosis of a cava-bronchial fistula. The fistula was surgically repaired, and the patient made a satisfactory recovery.