Expectoration of the staple line: A delayed complication after previous lobectomy

Giovanni Leuzzi, Gabriele Alessandrini, Daniele Forcella, Francesco Facciolo

Research output: Contribution to journalArticlepeer-review


In the literature, bronchopleural fistula after thoracic surgery is usually reported in the perioperative setting; however, the incidence of delayed fistula still remains unknown. We herein report a case of a 54-year old man who was referred to the Emergency Department for dyspnoea and productive cough with expectoration of a whitish 'suture-like' tissue. Two months before, the patient underwent an uneventful right lower lobectomy for squamous-cell lung cancer. A computed tomography scan revealed a para-mediastinal localized pneumothorax (measuring 6 cm in the major axis) starting from a right lower bronchus interruption associated with a middle lobe consolidation. The patient was consequently admitted for respiratory monitoring and underwent a fibre-optic bronchoscopy to assess bronchial integrity: the right lower bronchus was completely dehiscent and connected to an empty pleural closed pouch, with no inflammatory signs or sputum-like effusion. After the procedure, the clinical course was unremarkable with gradual improvement of clinical conditions: in particular, the cough disappeared and no sign of fever, leucocytosis or respiratory failure was observed. Thus, after a multidisciplinary meeting, the patient was discharged 7 days after admission and re-evaluated monthly. Six months after diagnosis, the patient was symptom-free with complete closure of the fistula on radiological imaging.

Original languageEnglish
Pages (from-to)672-676
Number of pages5
JournalInteractive Cardiovascular and Thoracic Surgery
Issue number5
Publication statusPublished - May 1 2015


  • Bronchial stump
  • Bronchopleural fistula
  • Cough
  • Lobectomy
  • Staple

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery


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