Emergency drain for post pneumonectomy bronchopleural fistula: a drain placement technique based on the siphon principle

Bronchopleural fistula (BPF) after pneumonectomy is a life-threatening complication occurring in 2% to 16% of patients (1,2). Diagnosis of BPF should be prompt and is usually obtained with fiberoptic bronchoscopy and CT scan. After diagnosis, the first step is to drain the pleural cavity from the infected effusion (empyema), to prevent hypertensive mediastinal shift and aspiration pneumonia. It may be difficult to safely and correctly perform this manoeuvre because of: (I) the drastic change in anatomy following pneumonectomy, with diaphragm raising and mediastinal shift; (II) the need to drain the lowest part of the cavity effectively by the inserted drainage tube, whose tip should ideally be positioned in the deepest part of the chest (3,4)