[jdacespace]

No one knows for sure what this is. My name is Jason Vale and I had Cancer (the asking tumor) in my chest cavity muscles some 21 years ago. The operation took some ribs which were replace with marlex mesh or some type of plastic. After a recent bout with the flu, lung infection and bronchitis all at the same time the cough helped the effusion along an old scar track from the old chest tube that was in there 20 years ago. The bulge coming out of my side was lanced in Winthrop Hospital a couple of months ago and has been draining every day since. Along the line, a month in a half ago a second bump started coming out of my side. This one I cut open myself after seeing many doctors to no avail. Here is video of the mess I made and the mess that I'm still in. http://www.youtube.com/watch?v=Nsk7_J55ESE I am yet to find an infectious disease doctor who can put me on IV antibiotics to get rid of the infection to make any type of flap procedure easier. I dread going through a bunch of minor thorocotomies to get this thing fixed but if I have to I will. Any ideas. Watch the video but especially watch at exactly 3 minutes and 31 seconds. There is a definite hole in my lung somewhere. Is this a Bronchopleural fistula.

[Davy9]

1st off the manner in which you lanced yourself was not at all sterile. Though perhaps I can understand your frustration you really should not ever perform something like this on yourself again, ever. You stand to make matters far worse.

Yes it is infectious. But you will note that when you inhale that no air is sucked into either of those holes. That would not happen with an open pleural space. It appears that they drain when you tensely compress your abdominal muscles. That makes me think that the infection is pocketed either in the abdomen or in the cutaneous tissues around the cysts. They might be loculated pleural pockets. They should be able to locate the source of these on a CT or MRI scan. They need to be drained, and cleaned and kept clean. The drainage material should be cultured/analyzed to determine the causative organism and the best course of treatment.

A BP fistula is an open communication from inside the lungs to the pleural cavity and has no external communication. So this is not a BP fistula from what I can see. It is serious and it needs aggressive medical intervention. It is active and getting worse and your inquisitive procedure could have introduced further contamination. It is doctor time right now.

[jdacespace]

Thank you for your response. However, this is a bronchopleural fistual in that I can blow up a balloon with the amount of air I can push out. Pocketed spots has already been ruled out by me being able to empty my entire lung (which is not collapsed in spite of the hole due to it being cemented to my chest wall from a partial resection 20 years ago when they removed the bottom lobe.
As far as I understand the fistula can very well have a communication to the outside. It travels one way, outward, which of course makes this bad situation a little safer for me.
I went to my ID doctor yesterday, infectious disease, and he said the situation has not changed and I have it somewhat controlled, so he want to see in another couple of months. Of course if I come down with fevers, then I must realize that I've lost control and the flap operation is in order. I dread the thought of using muscle flaps to fill up the pleural space. Muscle flaps that I dont' have due to my 20 year old thorocotomy which cut through most of the usable muscle material in my left site.

[Davy9]

Okay lets assume you're correct. Your lung is adhesed and you have a check valve (unidirectional) BP fistula. On the video you used a lot of effort to force air through that fistula. When you do that it exacerbates the situation because it interrupts whatever healing might have occurred and/or makes the fistula worse. Should the fistula become open (patent or bi-directional) you will leak air with minimal effort and could tear a pleural adhesion precipitating a bleed and/or suffer a full or partial pneumothorax (collapsed lung) So obviously you should not intentionally put strain on that area.

Still this does not fully address the infection which appeared to be forming collateral localized abcesses. Have they done no cultures on that material? ....any blood cultures? ....what is your white cell count and sed rate? In other words how are they tracking, diagnosing and treating the infection? You certainly do not want an active infection eating away at any viable tissues and leading to even more scarring. Would they consider lavaging with appropriate antibiotics? Obviously how you manage those wounds is also of great importance. What you demonstrated was not good wound management. There are wound care specialists and home nursing services that can help.

You clearly are in a unique situation. Your goal should be to minimize this acuity in order to minimize any additional long term sequelae. You want to return back to having a closed chest wall and no infection.