Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant
Airway complications after lung transplantation are a major cause of morbidity and mortality. Bronchial dehiscence presents within a month of lung transplantation and is typically diagnosed radiographically as a sentinel gas pocket at the anastomotic site and confirmed with bronchoscopy. A 66-year-o...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Pulmonology |
| Online Access: | http://dx.doi.org/10.1155/2020/8830361 |
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| author | Linda P. Vien Robert M. Marron Abbas Charlie Maruti Kumaran James C. Brown |
| author_facet | Linda P. Vien Robert M. Marron Abbas Charlie Maruti Kumaran James C. Brown |
| author_sort | Linda P. Vien |
| collection | DOAJ |
| description | Airway complications after lung transplantation are a major cause of morbidity and mortality. Bronchial dehiscence presents within a month of lung transplantation and is typically diagnosed radiographically as a sentinel gas pocket at the anastomotic site and confirmed with bronchoscopy. A 66-year-old man with idiopathic pulmonary fibrosis who underwent a right lung transplantation 4 weeks prior developed chest pain with palpable crepitus over his right chest wall. A chest X-ray revealed subcutaneous emphysema and a small right-sided pneumothorax. Computed tomography (CT) of the thorax without contrast revealed a gas pocket at the anastomotic site in the mediastinum as well as interstitial emphysema around the proximal bronchi of the right lung that had worsened when compared to CT from 11 days prior. A review of prior CT demonstrated interstitial emphysema without evidence of a sentinel gas pocket. These findings suggest that interstitial emphysema was the initial radiographic manifestation of the bronchial anastomotic site dehiscence. Interstitial emphysema is typically self-limiting, but severe cases can lead to major complications. Interstitial emphysema outside of the immediate postoperative period should be recognized as a possible early radiographic sign of bronchial dehiscence in lung transplant patients with vigilant monitoring of potential complications and strong consideration for early bronchoscopic investigation. |
| format | Article |
| id | doaj-art-877d44c377714ff881f76a3eef695083 |
| institution | Kabale University |
| issn | 2090-6846 2090-6854 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
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| series | Case Reports in Pulmonology |
| spelling | doaj-art-877d44c377714ff881f76a3eef6950832025-08-20T03:37:43ZengWileyCase Reports in Pulmonology2090-68462090-68542020-01-01202010.1155/2020/88303618830361Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung TransplantLinda P. Vien0Robert M. Marron1Abbas Charlie2Maruti Kumaran3James C. Brown4Department of Medicine, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USADepartment of Thoracic Medicine and Surgery, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USADepartment of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USADepartment of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USADepartment of Thoracic Medicine and Surgery, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USAAirway complications after lung transplantation are a major cause of morbidity and mortality. Bronchial dehiscence presents within a month of lung transplantation and is typically diagnosed radiographically as a sentinel gas pocket at the anastomotic site and confirmed with bronchoscopy. A 66-year-old man with idiopathic pulmonary fibrosis who underwent a right lung transplantation 4 weeks prior developed chest pain with palpable crepitus over his right chest wall. A chest X-ray revealed subcutaneous emphysema and a small right-sided pneumothorax. Computed tomography (CT) of the thorax without contrast revealed a gas pocket at the anastomotic site in the mediastinum as well as interstitial emphysema around the proximal bronchi of the right lung that had worsened when compared to CT from 11 days prior. A review of prior CT demonstrated interstitial emphysema without evidence of a sentinel gas pocket. These findings suggest that interstitial emphysema was the initial radiographic manifestation of the bronchial anastomotic site dehiscence. Interstitial emphysema is typically self-limiting, but severe cases can lead to major complications. Interstitial emphysema outside of the immediate postoperative period should be recognized as a possible early radiographic sign of bronchial dehiscence in lung transplant patients with vigilant monitoring of potential complications and strong consideration for early bronchoscopic investigation.http://dx.doi.org/10.1155/2020/8830361 |
| spellingShingle | Linda P. Vien Robert M. Marron Abbas Charlie Maruti Kumaran James C. Brown Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant Case Reports in Pulmonology |
| title | Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant |
| title_full | Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant |
| title_fullStr | Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant |
| title_full_unstemmed | Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant |
| title_short | Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant |
| title_sort | interstitial emphysema as a rare radiographic presentation of bronchial dehiscence after lung transplant |
| url | http://dx.doi.org/10.1155/2020/8830361 |
| work_keys_str_mv | AT lindapvien interstitialemphysemaasarareradiographicpresentationofbronchialdehiscenceafterlungtransplant AT robertmmarron interstitialemphysemaasarareradiographicpresentationofbronchialdehiscenceafterlungtransplant AT abbascharlie interstitialemphysemaasarareradiographicpresentationofbronchialdehiscenceafterlungtransplant AT marutikumaran interstitialemphysemaasarareradiographicpresentationofbronchialdehiscenceafterlungtransplant AT jamescbrown interstitialemphysemaasarareradiographicpresentationofbronchialdehiscenceafterlungtransplant |