A Tale of Two Passages of Air Leaks in a Single Patient with Lung Carcinoma Posing a Challenge During Mechanical Ventilation

Irtiqa Sheikh; Puneet Khanna; Sumit Roy Chowdhury

doi:10.4103/ijrc.ijrc_131_21

SEARCH WITHIN CONTENT

Online First

A Tale of Two Passages of Air Leaks in a Single Patient with Lung Carcinoma Posing a Challenge During Mechanical Ventilation

Irtiqa Sheikh, Puneet Khanna, Sumit Roy Chowdhury

Keywords : Bronchopleural fistula, carcinoma, lung cancer, mechanical ventilation, non-small cell lung, tracheoesophageal fistula, videolaryngoscope

Citation Information : Sheikh I, Khanna P, Chowdhury SR. A Tale of Two Passages of Air Leaks in a Single Patient with Lung Carcinoma Posing a Challenge During Mechanical Ventilation. Indian J Respir Care 2022; 11 (1):71-73.

DOI: 10.4103/ijrc.ijrc_131_21

License: CC BY-NC-SA 4.0

Published Online: 06-12-2022

ARTICLE
REFERENCES

Abstract

Lung carcinoma may erode into different adjacent structures and cause various local complications, including the formation of fistulas. A middle-aged male with a history of fever, cough with hemoptysis, and progressive dyspnea was found to have right upper lobe non-small cell carcinoma of the lung. Subsequently, he developed right pyopneumothorax and persistent air leak suggestive of bronchopleural fistula and suffered hypoxic cardiac arrest. Postintubation and return of spontaneous circulation, the patient started exhibiting persisted air leak from oral cavity, which made ventilation difficult along with leak via chest drain. An ulcer around the upper esophagus necessitated a computed tomography scan, which revealed two trachea-esophageal fistulas. Left-sided one-lung ventilation was employed, which improved ventilation, but the patient succumbed to the underlying disease process and septic shock. On the background of lung carcinoma and a known leaking process, a source of a second leak can often be missed. Positive pressure ventilation can be a daunting task in the presence of two concomitant leaking processes. Thus, it is imperative for an intensivist to have a high index of suspicion to detect such occurrence in a patient with lung carcinoma.

HTML PDF Share

Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA. Non-small cell lung cancer: Epidemiology, risk factors, treatment, and survivorship. Mayo Clin Proc 2008;83:584-94.
Blasberg JD, Kim C, Chilakamarry S. Special types of lung cancer. In: Tanoue L, Detterbeck F, editors. Lung Cancer: A Practical Approach to Evidence-Based Clinical Evaluation and Management. St Louis: Elsevier; 2018. p. 131-46.
Marulli G, Battistella L, Mammana M, Calabrese F, Rea F. Superior sulcus tumors (Pancoast tumors). Ann Transl Med 2016;4:239.
Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome. J Thorac Cardiovasc Surg 1992;104:1456-64.
Leo F, Solli P, Veronesi G, Galetta D, Petrella F, Gasparri R, et al. Review on bronchopleural fistula: Did a surgeon review it? Chest 2006;129:1731.
Chauhan SS, Long JD. Management of tracheoesophageal fistulas in adults. Curr Treat Options Gastroenterol 2004;7:31-40.
Performance scales: Karnofsky and ECOG scores. Available from: https://oncologypro.esmo.org/oncology-in-practice/practice-tools/performance-scales. [Last accessed on 29.12.2021].

PDF Share