Surgical infections · 2025
Late Recurrence of Empyema More Than a Decade after Window Thoracostomy: Secondary Aspergillus Infection Superimposed on Prior MRSA Empyema, Successfully Managed by Stepwise Surgical and Endobronchial Definitive Closure.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kondo Kaoru, Tanaka Shin, Yamamoto Haruchika, Nakashima Kumi, Torigoe Hidejiro, Suzawa Ken, Shien Kazuhiko, Miyoshi Kentaroh, Okazaki Mikio, Sugimoto Seiichiro, Toyooka Shinichi
Аннотация
BACKGROUND: Fungal empyema is uncommon and has worse short-term outcomes than bacterial disease, particularly when a bronchopleural fistula (BPF) sustains contamination.
CASE: A previously healthy male developed BPF and methicillin-resistant Staphylococcus aureus (MRSA) empyema after right upper lobectomy at age 17, managed by open-window thoracostomy (OWT). An apical residual space persisted and formed a fungus-ball-like nodule. At age 30, he re-presented with fever and nodule growth, with elevated Aspergillus IgG; voriconazole was started.
MANAGEMENT: Computed tomography-guided catheter placement and re-OWT exposed air leaks and recurrent MRSA. Staged fistula control with endobronchial Watanabe spigots, n-butyl-2-cyanoacrylate, and cavity-side suturing achieved cessation.
OUTCOME: After irrigation, sterilized cultures, negative-pressure therapy preceded latissimus dorsi flap obliteration. He was discharged on postoperative day 149 without recurrence.
CONCLUSIONS: A stepwise plan-source control, fistula control, sterilization, and obliteration-can achieve durable cure in mixed Aspergillus-MRSA empyema with BPF after prior OWT.
CASE: A previously healthy male developed BPF and methicillin-resistant Staphylococcus aureus (MRSA) empyema after right upper lobectomy at age 17, managed by open-window thoracostomy (OWT). An apical residual space persisted and formed a fungus-ball-like nodule. At age 30, he re-presented with fever and nodule growth, with elevated Aspergillus IgG; voriconazole was started.
MANAGEMENT: Computed tomography-guided catheter placement and re-OWT exposed air leaks and recurrent MRSA. Staged fistula control with endobronchial Watanabe spigots, n-butyl-2-cyanoacrylate, and cavity-side suturing achieved cessation.
OUTCOME: After irrigation, sterilized cultures, negative-pressure therapy preceded latissimus dorsi flap obliteration. He was discharged on postoperative day 149 without recurrence.
CONCLUSIONS: A stepwise plan-source control, fistula control, sterilization, and obliteration-can achieve durable cure in mixed Aspergillus-MRSA empyema with BPF after prior OWT.