Pneumonectomy Complicated by Bronchopleural Fistula and Empyema

Thoracic empyema with or without an associated bronchopleural fistula (BPF) is one of the most common complications after a pneumonectomy. We discuss the case of a 72-year-old gentleman with stage III poorly differentiated squamous cell carcinoma of the lung, who underwent right thoracoscopic pneumonectomy and mediastinal lymphadenectomy. Postoperatively, he developed a BPF and empyema with quinolone-resistant Pseudomonas aeruginosa. Subsequently, he underwent a right thoracoscopic drainage and debridement of the chest cavity followed by repair of the BPF with omental pouch. He was then treated with intravenous tigecycline and meropenem for 20 days with gradual clinical improvement. We discuss the pathophysiology of empyema, microorganisms involved, and the role of appropriate antibiotic therapy. We also describe various preoperative and intraoperative strategies to prevent the development of empyema and how both medical and surgical interventions play an important role in the management of these patients.