Korean J Radiol.  2016 Apr;17(2):295-301. 10.3348/kjr.2016.17.2.295.

Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

• Yoon HJ
• Chung MJ
• Lee KS
• Kim JS
• Park HY
• Koh WJ

• KMID: 2360217
• DOI: http://doi.org/10.3348/kjr.2016.17.2.295

Abstract

OBJECTIVE
To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings.
MATERIALS AND METHODS
We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists.
RESULTS
The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion.
CONCLUSION
In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

Keyword

Mycobacterium avium complex; Lung; Hydropneumothorax; Broncho-pleural fistula; Pleural effusion; Computed tomography

MeSH Terms

Aged
Aged, 80 and over
Female
Fistula/complications
Humans
Hydropneumothorax/complications/microbiology/*radiography
Lung/radiography
Male
Middle Aged
Mycobacterium avium/*isolation & purification
Mycobacterium avium Complex/isolation & purification
Mycobacterium avium-intracellulare Infection/*diagnosis/microbiology
Pleural Diseases/complications/microbiology/*radiography
Pleural Effusion/complications
Retrospective Studies
*Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Chest radiograph and CT images obtained from 86-year-old man with pulmonary disease and hydropneumothorax caused by Mycobacterium avium (Case 4). A. Chest radiography shows hydropneumothorax (arrow) in right hemithorax. Small cavitary or non-cavitary nodules and branching nodular structures (tree-in-bud pattern) (arrowheads) are seen in both lungs. B. CT images with lung and mediastinal window setting demonstrate hydropneumothorax and enhancing pleural thickening suggesting pleural empyema. Note broncho-pleural fistulas (arrow) that developed from prior cavitary lesion (not shown) in same area.

• 

  Fig. 2 CT images showing broncho-pleural fistula (arrows) in each case with hydropneumothorax associated with Mycobacterium avium complex lung disease (A–D, Cases 1–3, and 5, respectively).

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