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J Thorac Cardiovasc Surg 2001;121:1194-1195
© 2001 The American Association for Thoracic Surgery

Brief Communications

Bilobectomy for massive hemoptysis after bilateral lung transplantation

From the Departments of Cardiothoracic and Vascular Surgery,^a Internal Medicine III,^b and Anaesthesiology,^c Johannes Gutenberg–University, Mainz, Germany.

Received for publication Aug 14, 2000. Accepted for publication Oct 23, 2000. Address for reprints: Stefan Guth, MD, Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg– University Hospital, Langenbeckstr. 1, D-55101 Mainz, Germany (E-mail: guth@mail.uni-mainz.de).

A bronchovascular fistula is a rare but life-threatening complication after lung transplantation. We report a case of massive hemoptysis after bilateral lung transplantation successfully treated by a lower bilobectomy.

Clinical summary

A 27-year-old man underwent bilateral lung transplantation for cystic fibrosis on December 6, 1998. The total ischemic time was 300 minutes for the left lung allograft and 390 minutes for the right lung allograft. Eight hours after the operation, a rethoracotomy was necessary for significant diffuse bleeding from the thoracic wall. Thereafter, the patient's clinical condition remained stable and extubation was performed on postoperative day 1. Microbiological examinations of the donor bronchus revealed Pneumococcus, Staphylococcus aureus, and hemolytic Streptococcus. The initial antibiotic regimen consisted of ceftazidime, floxacillin (INN: flucloxacillin), amikacin, and itraconazole. Within the first 2 weeks bilateral perihilar and basal infiltrates were demonstrated by chest x-ray films. Early laboratory tests confirmed infection (C-reactive protein, 200 mg/dL). After specific antibiotic treatment, radiologic and laboratory parameters returned to within normal limits.

One day before the planned discharge from the hospital (postoperative day 32), a massive hemoptysis developed, with an estimated blood loss of 750 mL, and the patient was returned to the . . . [Full Text of this Article]

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