case_images: PMC7486421_01
case_images: Computed tomography showing the condition of the stump of the right lower lobe: only atelectasis of the middle lobe on day 6 (arrowhead) (a), and bronchopleural fistula (arrow) connecting to the limited pleural space (dashed line) was confirmed on day 12 (b). Bronchopleural fistula and pleural space were closed with the latissimus dorsi muscle without recurrence 9 months after closure (c).
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case_images: Fever (38.6  C) and increased inflammatory reactions (C-reactive protein, 18.34 mg/dL) appeared, and chest computed tomography (CT) demonstrated right middle lobe atelectasis on day 6 (Fig. 1a). Although CT revealed a BPF in the stump of the right lower bronchus on day 12 (Fig. 1b), aspiration pneumonia was minimal in the middle lobe and the size of the relevant pleural cavity was limited (56 cm3 on CT image analysis). Nine months after BPF closure, the middle lobe atelectasis improved and the pleural space was occupied by the PLD muscle flap without BPF and cancer recurrence (Fig. 1c).
case_images: Bronchoscopy showing an ischemic change at the membrane portion near the closed edge of the right lower bronchus on day 6 (a), which progressed to a large defect ranging from the stump of the lower bronchus to the lateral wall of the middle bronchus on day 18 (b). Intraoperative findings (c and d).. *, pleural cavity. PLD, pedicled latissimus dorsi.
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case_images: Bronchoscopy revealed an ischemic change of the bronchial stump without dehiscence, indicating ischemic bronchitis (Fig. 2a). However, fever reappeared reaching 39.4  C on day 18, and bronchoscopy revealed an enlarged bronchial defect (3.0 cm) ranging from the lower bronchus membranous portion to the lateral wall of the middle bronchus (Fig. 2b), which made us decide to perform surgical intervention. Thus, after pleural debridement, the PLD muscle flap harvested in the conventional manner was sutured on the edge cartilage of the bronchial defect with 6 strings of 4-0 absorbable monofilament to cover the bronchial defect and occupy the pleural cavity (Fig. 2c and d).