Pleurography (thoracography) for pleural fistulas: a case series

Abstract Background Pleurography(PG) has been described previously, but has never gained popularity. PG can determine the exact air leak points in the lung, which is important for treating pneumothorax and pleural fistulas. We believe that the usefulness of PG should be reassessed. We describe the method, the detection rates of the air leak points, and common complications. Methods From the 1,210 cases of pleural fistulas that were treated at our institution between March 2015 and October 2018, 275 patients of recurrence of primary pneumothoraxes or secondary spontaneous pneumothoraxes were selected for this study. PG was performed in 127 patients with persistentair leakage during exhalation. In addition, 35 patients with postoperative complications of air leakage continued for 7 days or longer were included. Results Air leak points were detected in 119 patients (73%): in the apex of the lung in 65 cases, the basal segment in 13 cases, and the middle lobe or lingular segment in 9 cases. There were 8 cases of hilar lesions, 12 cases of S6, 8 cases of upper lobe lesions other than apex, and 4 cases of upper mediastinal lesions. Complications within 30 days were observed in 10 cases (6.2%), with 8 grade-2 cases involving fever, one grade-3 case involving infection, and one grade-1 case with abdominal distension. Conclusions The incidence of grade 3 or higher adverse events after PG was 0.6%, which is considered acceptable. Our findings suggest that PG is a safe examination method to identify air leaks prior to surgery for pleural fistulas.