Bronchial dehiscence after lung transplantation: Correlation of CT findings with clinical outcome

PURPOSE: To determine whether computed tomography (CT) can help predict which patients will require surgical or bronchoscopic intervention during healing of bronchial anastomotic dehiscence after lung transplantation. MATERIALS AND METHODS: The authors followed up 25 bronchoscopically proved dehiscent anastomoses through healing in 19 patients who underwent lung transplantation. CT findings were correlated with bronchoscopic results and clinical outcome. RESULTS: A bronchial defect and extraluminal air were initially present at CT in all 25 dehiscent anastomoses. Of 12 bronchial defects less than or equal to 4 mm, only one required intervention during healing (P < .05). Of 12 bronchial defects greater than 4 mm, six required intervention during healing. Eight of nine dehiscences with a tiny or small amount of extraluminal air healed with conservative treatment. Of 16 dehiscences associated with a moderate to large amount of extraluminal air, nine were treated conservatively and six required therapeutic intervention. Three healing anastomoses required bronchial stent placement. One patient died in the perioperative period. CONCLUSION: In patients with small dehiscences (<4 mm) and patients with a tiny or small amount of extraluminal air, the anastomosis tends to heal without sequela. When patients have larger amounts of extraluminal air or larger (>4 mm) dehiscences at presentation, CT cannot help predict which patients will require intervention.