Radical extrapleural pneumonectomy with bronchial fistula by pulmonary function test evaluation technique

Our plain-English summary of Radical extrapleural pneumonectomy with bronchial fistula by pulmonary function test evaluation technique, by S. Marzban-Rad, R. Bozorgmehr, P. Sattari, et al (Annals of Medicine and Surgery, 2021).

The study

• Authors: S. Marzban-Rad, R. Bozorgmehr, P. Sattari, G. Azimi, A. Azimi
• Journal: Annals of Medicine and Surgery
• Published: 2021;72:103071
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: and importance: Pulmonary Function Tests (PFTS) is an important tool in the assessment of pulmonary pathologies and preoperative evaluation. Case presentation: A 54-year-old man with history of massive pleurisy in the left thorax, treated by placing chest tube and drainage of bloody effusion, was readmitted for epithelioid mesothelioma. He was then presented with pneumothorax due by a refractory bronchial fistula while having a plural catheter. Based on the consultation, the whole-body bone scan was conducted, and findings demonstrated epithelioid mesothelioma (stage 1) with the refractory fistula for which the patient was candidate for thoracic surgery. Decreased lung capacity was seen by Pulmonary Function Testing - PFTS.

Clinical Discussion: The novel PFTS Evaluation Technique was designed to measure the true pulmonary capacities in order to evaluate the pulmonary post-operative tolerance. In this technique the chest tube was placed for 4 weeks until the patient reaches mediastinal fixation then the measurements by PFTS were carried out in two steps. First, using an open chest tube and second, using a clamped chest tube. In both steps, the pulmonary capacities were measured and provided to the pulmonologist for consultation.

Conclusion: In this case, after acquiring the approval of the specialist depended on PFTS after PFTS Evaluation Technique, the radical extra pleural pneumonectomy surgery was conducted, and the patient was discharged with a good general appearance and treated fistula.

© 2021 The Authors.

In plain English

This article was a case report about one patient: a 54-year-old nonsmoking male veteran with malignant mesothelioma of epithelioid type in the lining of the left lung (pleura). He had large bloody fluid collections around the left lung, then an air leak from the airway (a bronchial fistula). A pulmonologist advised against surgery because a quantitative lung function scan, needed to judge how the lungs would tolerate it, could not be performed. The authors kept a chest tube in place on suction for 4 weeks to hold the central chest in position (mediastinal fixation). They then ran the breathing test twice, first with the tube open and then with it clamped. The values recorded with the clamped tube were higher than those recorded before fixation. After this, the patient had a radical extrapleural pneumonectomy, an operation removing the lung and the lining around it. He was discharged with a good general appearance and the fistula treated. The biopsy noted a few pigments similar to asbestos bodies. The report gave no history of asbestos exposure. The authors did not discuss limitations of their report.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 54-year-old nonsmoking male veteran with shortness of breath, first diagnosed with left-sided pleurisy in June 2019. All authors are affiliated with institutions in Tehran, Iran; the article does not say where the patient was treated.
• Exposure: No asbestos exposure history was reported for the patient. The biopsy noted a few pigments similar to an asbestos body; no fiber type was named.
• Main results:
  • Pathology of the surgical specimen showed a malignant tumour of the pleura with tubulopapillary configuration and stromal invasion, consistent with malignant mesothelioma of epithelioid type.
  • A pulmonologist advised that surgery could not be done because the quantitative pulmonary function scan to evaluate post-surgery lung tolerance could not be performed.
  • After 4 weeks of mediastinal fixation using a chest tube with suction, spirometry was done first with the chest tube open and then with it clamped.
  • Before mediastinal fixation (07/09/2019), the patient's values in the columns labelled FEVI and FVE were 67.7 and 68.4. No units were given.
  • After mediastinal fixation (26/09/2019), the FEVI and FVE values were 85 and 76 with the tube open, and 91 and 81 with the tube clamped. No units were given.
  • After approval based on these tests, the patient underwent radical extrapleural pneumonectomy. He was discharged with a good general appearance and treated fistula.
• The authors' conclusion: The authors concluded that when a patient with a pulmonary fistula cannot undergo pneumonectomy for lack of reliable lung function test information, radical extrapleural pneumonectomy surgery can be effective (the sentence is garbled in the original).

Topics

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pulmonary Function Test (PFT), Pleurisy, Thorax, Epithelioid, Mesothelioma, Pneumothorax, Thoracic Surgery.

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