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Bronchopericardial fistula, an unusual complication of oxytetracycline sclerosis therapy

Adem Grbolar^b, Lawand Qaradaghi^a,*, Yildirim Imren^a, Irfan Tasoglu^c, Elif Coskun^a and Tugba Avc^a

^a Department of Cardiovascular Surgery, Gazi University Hospital, Besevler, Ankara, Turkey
^b Department of Cardiovascular Surgery, Private Mesa Hospital, Ankara, Turkey
^c Department of Cardiovascular Surgery, Yuksek Ihtisas Hospital, Ankara, Turkey

*Corresponding author. Tel.: +90 312 202 67 37; fax: +90 312 212 90 14.

E-mail address: lawand_mahmood{at}yahoo.com (L. Qaradaghi).

Here we report a rare case of bronchopericardial fistula following intrapericardial instillation of oxytetracycline. A 63-year-old female patient was admitted for management of malignant pericardial effusion secondary to right-sided bronchogenic carcinoma. Medical therapy and recurrent percutaneous catheter drainage failed in resolving the problem, so subxiphoid pericardiostomy and drainage tube insertion was performed. There was no decrease in the drainage so we decided to perform pericardial sclerosis by intrapericardial tetracycline instillation. After the second time oxytetracycline instillation, the patient developed respiratory arrest with hemodynamic instability. A huge amount of yellow frothy secretion aspirated through the endotracheal tube. The presence of tetracycline in the bronchial secretion was proved by microbiological methods. The hemodynamic status of the patient deteriorated rapidly and despite all resuscitation measures we lost the patient within a few hours.

Key Words: Bronchopericardial fistula; Pericardial effusion; Tetracycline