4 Brown RG, Fleming WH, Juriliewicz MJ. An island Oap of the pectoralis major muscle. Br J Plastic Surg 1977; 30:161-65 5 Ali J, Hardinl B, deNiord R. Effect of temporary external stabilization on ventilator weaning after sternal resection. Chest 1989; 95:472-73 6 Hill NS. Clinical applications of body ventilations. Chest 1986; 90:897-905 7 Kinnear \v, Peich M, Taylor G, Sheenson J. Assisted ventilation using cuirass respirators. Eur Respir J 1988; 1:198-203 8 Mohr CH, Hill NS. Long term follow-up of nocturnal ventilatory assistance in patients with respiratory failure due to Duchennetype muscular dystrophy. Chest 1990; 97:91-6 9 Splainlard ML, Frates RC, Jefferson LS, Rosen CL, Harrison GM. Home negative pressure ventilation: report of 20 years of experience in patients with neuromuscular disease. Arch Phys Med Rehabill985; 66:239-41 10 Goldstein RS, Molotiv N, Skrastins R, Long S, De Rosie J, Contreras M, et aI. Reversal of sleep-induced hypoventilation and chronic respiratory failure by nocturnal negative pressure ventilation in patients with restrictive ventilatory impairment. Am Rev Respir Dis 1987; 135:1049-55 11 Gutierrez M, Beroiza T, Contreras G, Diaz 0, Cruz E, Moreno R, et aI. Weekly cuirass ventilation improves blood gases and inspiratory muscle strength in patients with chronic airOow limitation and hypereardia. Am Rev Respir Dis 1988; 138:61723 12 Fulkerson WJ, Wilkins JK, Esbenshade AM, Eskind JB, Newman JH. Life threatening hypoventilation in kyphoscoliosis: successful treatment with a molded body brace-ventilator. Am Rev Respir Dis 1984; 129:185-87 13 Kinnear \v, Hockley S, Harvey J, Shneerson J. The effects of one year of nocturnal cuirass-assisted ventilation in chest wall disease. Eur Respir J 1988; 1:204-08 14 Garay SM, Turino GM, Goldring RM. Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Am J Med 1981; 70;269-74 15 Cropp A, Dimarco AF. Effects of intermittent negative pressure ventilation on respiratory muscle function in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1987; 135:1056-61 16 Driver AG, Blackburn BB, Mareuard Sf, Austin EH. Bilateral diaphragm paralysis treated with cuirass ventilation. Chest 1987; 92:683-85 17 Sanyal SK, Bernal R, Hugitis WT, et aI. Continuous negative chest-wall pressure: successful use for respiratory distress in an adult. JAMA 1976; 236:1727 18 Morris AH, Elliott CG. Adult respiratory distress syndrome: successful support with continuous negative extrathoracic pressure. Crit Care Med 1985; 13:989-90
A 56-year-old man with metastatic prostatic carcinoma underwent placement of a Hickman catheter. Approximately two months after the procedure, he was admitted to the hospital with hemoptysis and in respiratory distress. A contrast computed tomographic (Cf) scan con6rmed the diagnosis of a cava-bronchial 6stula. The 6stula was surgically repaired, and the patient made a satisfactory recovery. (Chest 1992; 102:1285-86)
S
ilastic central vein catheters generally have been found to be safe from complications. I Their flexibility, ease of insertion, and relative inertness have led to their popularity for long-term central venous use. Erosion of polyvinyl chloride catheters has been recognized more frequently, although still quite rare.' These generally result in a hemothorax or tamponade. Hemoptysis follOwing erosion of a catheter into a bronchus with either type, however, is exceedingly rare. CASE REPORT
A 56-year-old man with a history of metastatic prostatic cancer had a Hickman line placed into his right superior vena cava via left subclavian approach for infusional chemotherapy with Ouoroumcil. Six weeks later, he developed a productive L'Ough and hoarseness. On examination, breath sounds were normal. Although both vocal cords moved normally, inOammation was noted. Chest roentgeno· gram showed a small right effusion with an elevated right hemidiaphragm. He was placed on a regimen of amoxicillin. Two weeks later, the patient was feeling better but had noted blood-Oecked sputum on occasion. Two days later, he presented to the emergency department with severe dyspnea. On examination, he was tachypneic and tachycardiac. Breath sounds were diminished on his right side. Chest roentgenogram showed a large effusion on his right with an elevated right hemidiaphragm. A mmputed tomographic (Cf) scan of his chest demonstmted no mediastinal or hilar adenopathy. With intravenous (IV) mntrast, the patient began coughing. Subsequent images revealed mntrast layering in his trachea (Fig 1). The patient was taken to the operating room «Ir repair of a cavabronchial fistula. He underwent bronchos
A 56-year-old man with metastatic prostatic carcinoma underwent placement of a Hickman catheter. Approximately two months after the procedure, he was admitted to the hospital with hemoptysis and in respiratory distress. A contrast computed tomographic (Cf) scan con6rmed the diagnosis of a cava-bronchial 6stula. The 6stula was surgically repaired, and the patient made a satisfactory recovery. (Chest 1992; 102:1285-86)
S
ilastic central vein catheters generally have been found to be safe from complications. I Their flexibility, ease of insertion, and relative inertness have led to their popularity for long-term central venous use. Erosion of polyvinyl chloride catheters has been recognized more frequently, although still quite rare.' These generally result in a hemothorax or tamponade. Hemoptysis follOwing erosion of a catheter into a bronchus with either type, however, is exceedingly rare. CASE REPORT
A 56-year-old man with a history of metastatic prostatic cancer had a Hickman line placed into his right superior vena cava via left subclavian approach for infusional chemotherapy with Ouoroumcil. Six weeks later, he developed a productive L'Ough and hoarseness. On examination, breath sounds were normal. Although both vocal cords moved normally, inOammation was noted. Chest roentgeno· gram showed a small right effusion with an elevated right hemidiaphragm. He was placed on a regimen of amoxicillin. Two weeks later, the patient was feeling better but had noted blood-Oecked sputum on occasion. Two days later, he presented to the emergency department with severe dyspnea. On examination, he was tachypneic and tachycardiac. Breath sounds were diminished on his right side. Chest roentgenogram showed a large effusion on his right with an elevated right hemidiaphragm. A mmputed tomographic (Cf) scan of his chest demonstmted no mediastinal or hilar adenopathy. With intravenous (IV) mntrast, the patient began coughing. Subsequent images revealed mntrast layering in his trachea (Fig 1). The patient was taken to the operating room «Ir repair of a cavabronchial fistula. He underwent bronchos
