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Development of alveolar-pleural fistula during hepatectomy - A case report -
Anesth Pain Med 2019;14(4):456-9
Published online October 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Jun Hyun Kim , Sunghyeok Park , and Ji Yeon Kim
Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
Correspondence to: Ji Yeon Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea Tel: 82-31-910-7160 Fax: 82-31-910-7184 E-mail:
Received January 21, 2018; Revised April 9, 2019; Accepted April 16, 2019.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: An Alveolar-pleural fistula is communication between the alveoli and the pleural space that may result in intractable pneumothorax, severe infection, respiratory failure, physical weakness, and even death.
Case: A 70-year-old male underwent right hepatectomy with a cystic mass of the liver. During the operation, peak airway pressure abruptly increased and a serous fluid was regurgitated through the endotracheal tube. Lung isolation was immediately performed with a double-lumen endotracheal tube. Approximately 1,000 ml of exudate was drained through endotracheal tube. Thoracostomy was performed at right lung. Analysis of fluid from endotracheal tube and pleural effusion consistent with parapneumonic effusion.
Conclusions: We presented a case of alveolar-pleural fistula caused by pneumonia presenting with massive exudate fluid regurgitated from the endotracheal tube that was managed with bronchial suction, lung isolation, and thoracostomy and improved without surgical repair of the fistula.
Key Words : Fistula; Hepatectomy; One lung ventilation; Pleural effusion.

October 2019, 14 (4)
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