Clinical features and management strategies for pulmonary infections related to bronchobiliary fistula
Objective To analyze the characteristics,diagnosis,and treatment of pulmonary infections related to bronchobiliary fistula(BBF),and to enhance the understanding of this disease.Methods A total of 33 patients with pulmonary infections related to BBF hospitalized at the Third Affiliated Hospital of Naval Medical University from January 2011 to January 2024 were included in this study.The clinical retrospective case series research method was used to collect and analyze the clinical data of the included patients,including age,clinical manifestations,laboratory tests,imaging studies,bronchoscopy,cholangiography,and treatment.Results The age of the 33 patients was(51.4±7.9)years.The most common symptoms were coughing and biliary sputum(33/33,100.0％),followed by fever(23/33,69.7％).Other common symptoms included chest tightness,dyspnea,chest pain and hemoptysis.Bilirubin tests on sputum were performed in seven cases and on pleural effusions in four cases,and all were positive.Imaging studies revealed pneumonia in all patients,which was adjacent to the diaphragm.All patients had pleural effusion,with additional common findings included subphrenic effusion,liver abscesses,bile duct dilation,and gas in the bile duct.Bronchoscopy was performed on six patients,all of whom exhibited golden yellow biliary secretions.The presence of BBF was confirmed through percutaneous transhepatic cholangiography(6/10),T-tube cholangiography(3/6),and endoscopic retrograde cholangiopancreatography(5/18)in some patients.All patients received anti-infective therapy and supportive treatment.Among the 33 patients,18(54.5％)cases underwent endoscopic nasobiliary drainage,12(36.4％)percutaneous transhepatic biliary drainage,19(57.6％)thoracentesis,17(51.5％)subphrenic effusion drainage,five(15.2％)liver abscess drainage,13(39.4％)abdominal paracentesis,and six(18.2％)brochosopic embolization of bronchial fistula.Only three patients underwent surgical intervention when non-surgical treatments failed.Conclusions The clinical manifestations of pulmonary infections related to BBF are complex.When patients with hepatobiliary diseases present with coughing and biliary sputum,BBF should be highly suspected.Early diagnosis can be achieved through bilirubin testing of sputum or pleural effusion.The main treatments are biliary drainage or percutaneous puncture drainage and other non-surgical treatments.Surgical treatment could be considered only after the failure of non-surgical treatments.
Bronchobiliary fistulaPulmonary infectionClinical featuresDiagnosis and management strategies
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