another word for a big presentation

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a large amount of ice, snow, and rock falling quickly down the side of a mountain

Keeping up appearances (Talking about how things seem)

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Home Blog Presentation Ideas Powerful Words to Use in Presentations: Ultra Long List 

Powerful Words to Use in Presentations: Ultra Long List 

The power of words is immense and palpable when it comes to sharing ideas with others. The way you frame your sentences and cherry-pick specific words will affect how the audience preserves you. Not just that. Well-selected power words can shape narratives around businesses, distort (positively and negatively) their perception, and impact the listener’s decision to purchase. That’s why top copywriters and public speakers alike spend a great deal of time brainstorming different word combos and obsessing over their selection of action verbs, adjectives, and linking phrases.

Granted, you no longer need to do that. Just grab a PowerPoint template of your choice and start populating it with our big list of power words! 

What are Power Words?

Power words are persuasive words and phrases that evoke a positive or negative emotional response. Our selection of verbs, adjectives, and adverbs can convey different emotions from slight excitement to rightful outrate. That’s why public speakers , authors, and copywriters always carefully choose their words to convey the right idea and sentiment. 

Power words and phrases can make the same idea sound very different. Let’s take Apple’s famous slogan as an example: Think different. 

You can also convey the same idea using other descriptive words: Don’t think like everybody else, think outside the box, be creative 

However, each variation has a somewhat different ring to it. Ultimately, your word choice also impacts how others perceive you based on your speech.

Researchers found that word selection can have a massive impact on people, businesses, and society as a whole. Individual word choices can indicate the speaker’s mental state and impact the outcomes of a negotiation. Business power words shape customer experience with the brand and affect conversions. Action words, chose by the media, influence public perception of a social issue. 

Interestingly a group of researchers from Wilfrid Laurier University in Canada and Wharton in the US also found that word choices impact the song’s popularity. By applying text mining analytics to Billboard charts, the group found that songs with somewhat more unique texts performed better than those with pretty standard lyrics. A 16% differentiation in lyrical topics within a song was enough to propel it higher than songs in similar genres. 

The takeaway:

Our word choices have a profound impact on how others perceive us, as well as the actions they take afterward. Thus, if you want to be a Rockstar presenter , you need to choose your words carefully and prioritize powerful words! 

List of Powerful Words to Use in Presentations 

The English language has about 170,000 words in use . But an average person has an active vocabulary of 20,000 – 30,000 words. Among them is a smaller range of powerful adjectives and action verbs to make your presentations and speeches more impactful. 

Action Verbs to Use in Your PowerPoint Presentation

As the name implies, action verbs denote some dynamics — state, movement, result, etc. We use action verbs in our everyday speech a lot to describe what and how we do things. As author Elwyn Brooks White suggests : 

“Write with nouns and verbs, not with adjectives and adverbs. The adjective hasn’t been built that can pull a weak or inaccurate noun out of a tight place.”

Strong verbs don’t need adverbs to reinforce them. Compare these two statements: 

• I walked quickly towards the door. 
• I rushed out of the door. 

The first sentence merely states the fact. But the second one better conveys the emotion, the urgency of getting out of the room. It adds color to the narrative and sets the right mood.

In business presentations, action verbs help imply action to the user. They are good to use for both throughout the copy and the closing slide when you describe: 

• Main action points 
• Accomplishments
• Next steps 
• Results 

As you proofread your slide deck, look for weaker verbs and then replace them with stronger synonyms. Some common offenders include: 

• State-of-being verbs such as am, does, do, could, might, etc. While they have their merit, oftentimes, you can find a more descriptive alternative, conveying an extra emotion. 
• Verbs ending in -ing : wishing, planning, forgetting. Be bolder. Use present or past tenses instead. 
• Verbs in conjunction with an adjective: walked quickly, talked loudly, etc. Again, these can be replaced with snappier one-word alternatives. 

List of powerful verbs to make your language more persuasive: 

• Accelerate 
• Alter 
• Maintain 
• Regard 
• Convince 
• Boost 
• Ignite 
• Surge 
• Disrupt 
• Rejuvenate 
• Smash 
• Supercharge 
• Report 
• Change 
• Explore 
• Re-define 
• Strategize 
• Maximize 
• Capture 
• Achieve 

Powerful Adjectives to Use In Your Presentation 

The goal of adjectives is to reinforce your nouns and verbs. Use them to convey specific emotions and set the scene for the audience. 

But be sparring. You are not writing a novel. Too many adjectives can make your slide deck look cluttered, as you’d have to skim on white space to fit longer sentences. Also, excessive use of adjectives can muddle the main idea behind your key statements.

Below is our quick collection of power adjectives you can use to punch up your presentation: 

Power Words for Motivation

• Awe-inspiring
• Exquisite 
• Blissful 
• Brilliant 
• Dynamic 
• Burgeoning 
• Breathtaking
• Accomplished
• Successful 
• Enterprising 
• Venturesome
• Life-changing
• Encouraging 
• Baffling 
• Sensational 
• Incredible 

Power Words for Sales (Adjectives) 

• Cost-effective 
• Exorbitant 
• Knock-out 
• Science-proofed 
• Limited-time 
• Fully-booked
• Refundable 
• Negotiable 
• Below market average 
• Too-good-to-miss
• Budget-friendly
• Optimal 
• Exclusive 
• Time-sensitive
• Efficacious
• Sensible 
• Stylish 
• Unique 
• Profitable 

Power Adjectives to Persuade

• Verified 
• Risk-free 
• Effective 
• Tested 
• Solution-oriented
• Vetted 
• Non-negotiable
• Quality-controlled 
• Reliable 
• Legitimate 
• Lifetime 
• Market-tested 
• Foolproof 
• Surefire 
• Ingenious 
• Innovative 
• Cutting-edge 
• Exceptional 
• Game-changing
• Ground-breaking
• Flagship 
• Assured 
• Collateralized 
• Painless 
• Diciest 
• Tamperproof
• Immutable 

Coherence Markers 

Coherence markers are conversational words and phrases we use to denote logical connections between different ideas. They are not meaningful standalone words. Yet, they play a huge role in making your presentation copy more compelling.

Take a look at these two versions of Dove ad copy:

• Your skin’s natural oils keep it silky and supple. As you age, it becomes less elastic, and the production of oil slows down. Aging can cause dull, dehydrated skin.
• Your skin’s natural oils keep it silky and supple. But as you age, your skin becomes less elastic, and the production of oil slows down. That is why aging can cause dull, dehydrated skin.

The bolded coherence markers help digest the claims by establishing logical connections between the ideas. Research shows that adding such links to any copy (or speech) improves clarity and boosts persuasion. Therefore, sprinkle some coherence markers in your presentation to help the reader or lister mentally justify what you are saying. 

Coherence Markers to Use in a Presentation 

• Now do it 
• So go ahead
• Due to 
• That’s why 
• Given that 
• Here’s the deal:
• That’s right 
• By contrast 
• Beyond that 
• For starters
• What’s the bottom line?
• You might be wondering
• By now you should 
• Better still…
• The general conclusion is that
• Compound this with 
• What does this mean for you?
• Inferring from above 
• Just imagine
• You’ve tried everything. But
• You start to worry that
• Let me guess 
• What’s the catch?
• I know that’s what you’re thinking, right?
• But one thing’s for sure
• Let me say this straight
• Now consider it this way 
• It gest better (or worse)
• But here’s the kicker
• As if that’s not enough
• Best of all

Metaphors 

A metaphor is a figure of speech used to represent or symbolize another object or concept. For example, time is the greatest gift given to you . 

Writers love using metaphors to act depth and eloquence to their narrative. At the same time, top presenters use these to help the reader picture an intangible concept. 

As research found, metaphors help with persuasion by helping the reader or listener form a concrete mental image of the discussed concept. For example, you can say that your printing equipment works fast. But how fast do you mean? A metaphor can help make it more clear, e.g., “Our printing machines an equivalent of Ferrari in terms of speed.”  

Check our complete guide to using metaphors in presentations for more insights. Or swipe of some of the examples from our list below: 

Metaphors for Professional Presentations 

• Zeus-like 
• Drag-and-drop interfaces 
• To be worth waiting for 
• Glue for the Internet 
• To stay afloat 
• Off the shelf 
• Custom-made 
• To get up to speed
• App-like functionality 
• blue ocean / red ocean 
• Bumps on the road 
• Jump on the bandwagon 
• Tossed its cap
• The veneer on the credenza.
• Moonshot project
• More complicated than one-color puzzles.
• Lion-tamer-sky-diver fun
• Pack a punch 
• At the foothold of new 
• Buckets of questions 
• Going against the grain
• The epitome of something else
• From full throttle to a halt

To Conclude

Positive power words speak straight to the hearts and minds of the audiences. They encourage, inspire, motivate, bring up, and help move on in the right direction. If your goal is to hammer in a clear idea and prompt subsequent desirable action, these words are your best buddies to use all through your presentation slides and during delivery! 

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Synonyms for presentation

Synonyms for (noun) presentation.

Synonyms: demonstration , presentation , presentment

Definition: a show or display; the act of presenting something to sight or view

Usage: the presentation of new data; he gave the customer a demonstration

Similar words: show

Definition: the act of publicly exhibiting or entertaining

Usage: a remarkable show of skill

Synonyms: presentation

Definition: the activity of formally presenting something (as a prize or reward)

Usage: she gave the trophy but he made the presentation

Similar words: ceremony

Definition: the proper or conventional behavior on some solemn occasion

Usage: an inaugural ceremony

Synonyms: display , presentation

Definition: a visual representation of something

Similar words: representation

Definition: a creation that is a visual or tangible rendering of someone or something

Definition: (obstetrics) position of the fetus in the uterus relative to the birth canal

Usage: Cesarean sections are sometimes the result of abnormal presentations

Similar words: position , posture , attitude

Definition: the arrangement of the body and its limbs

Usage: he assumed an attitude of surrender

Definition: the act of making something publicly available; presenting news or other information by broadcasting or printing it

Usage: he prepared his presentation carefully in advance

Similar words: display

Definition: exhibiting openly in public view

Usage: a display of courage

Definition: the act of presenting a proposal

Similar words: proposal , proposition

Definition: the act of making a proposal

Usage: they listened to her proposal

Synonyms: presentation , intro , introduction

Definition: formally making a person known to another or to the public

Similar words: making known , informing

Definition: a speech act that conveys information

Visual thesaurus for presentation

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verb as in move smoothly; move down

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Example sentences.

Those opportunities could crystalize over the coming months, particularly as programmatic spending starts to recover from its coronavirus-induced slide.

More than just a looming monolith, though, the eccentric construction would have linked Chicago with New York and Boston via slides so the residents of those cities could toboggan to the Windy City for the fair.

The day of the presentation comes, and the e-commerce team gathers around, continuously nodding along with each slide.

You can take any blog article and create an infographic, video or slide presentation in order to mix things up.

All true enough — but those are just the most visible sites of the innovation chain, the kind of photos you see in IPO slide decks for so-called cutting-edge companies.

Near the door thousands of stilettos slide and shuffle on black ice, somehow always keeping their immaculate balance.

The reason is on the next slide, which is filled with public NIMBY complaints.

If the U.S. does nothing, the Arab world will continue its slide into sectarian bigotry, political repression, and madness.

There would be occasional periods of promise, but once the 1950s came it was a steady, painful downhill slide.

However, standard-speaking whites have a “warm” English they can slide into as well.

Practise gliding in the form of inflection, or slide, from one extreme of pitch to another.

Scratches and flaws in the glass of slide or cover are likewise a common source of confusion to beginners.

Touch the center of a cover-glass to the top of the drop and quickly place it, blood side down, upon a slide.

A rather large drop is taken upon a slide, covered, and examined with a low power.

A large drop is allowed to dry upon a clean slide or unglazed paper.

Related Words

Words related to slide are not direct synonyms, but are associated with the word slide . Browse related words to learn more about word associations.

verb as in work quickly through task

verb as in dislodge from staid position

• change position

noun as in ramp, slope

verb as in glide along without much effort

• ride on current

Viewing 5 / 72 related words

On this page you'll find 113 synonyms, antonyms, and words related to slide, such as: accelerate, drift, drive, drop, fall, and flow.

From Roget's 21st Century Thesaurus, Third Edition Copyright © 2013 by the Philip Lief Group.

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Thesaurus Definition of speech

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Releasing Windows 11, version 24H2 to the Release Preview Channel

• Windows Insider Program Team

UPDATE 5/29: We’re aware that some Windows Insiders in Release Preview are not seeing Windows 11, version 24H2 offered yet. We’ve just begun the rollout and will gradually increase the rollout over time so not everyone will see it right away. If you are not seeing it yet and want to update to Windows 11, version 24H2 right away, you can do so by using the ISO which are available for download here . The ISO is Build 26100.560 but once you update using the ISO and join Release Preview, you’ll get Build 26100.712.

Hello Windows Insiders!

Today, we are making this year’s annual feature update Windows 11, version 24H2 (Build 26100.712) available in the Release Preview Channel for customers to preview ahead of general availability later this calendar year.

Windows 11, version 24H2* includes a range of new features such as the HDR background support, energy saver, Sudo for Windows , Rust in the Windows kernel, support for Wi-Fi 7, voice clarity and more. It also includes many improvements across Windows. For example, we are introducing a scrollable view of the quick settings flyout from the taskbar, the ability to create 7-zip and TAR archives in File Explorer (in addition to ZIP), and improvements for connecting Bluetooth® Low Energy Audio devices. We will be sharing more details in the coming months on many of the new features and improvements included as part of Windows 11, version 24H2 leading up to general availability. Please note that the new AI features such as Recall announced earlier this week will not be available on your PC after installing this update today as they require a Copilot+ PC. For more information on those new AI features and Copilot+ PCs, see this blog post here .

As part of this update, we’re also evolving the Copilot** experience on Windows as an app that will be pinned to the taskbar. This enables users to get the benefits of a traditional app experience, including the ability to resize, move, and snap the window – feedback we’ve heard from users throughout the preview of Copilot in Windows. This model also allows Microsoft to more agilely develop and optimize the experience based on user feedback. This change will be making is way to Insiders in the Canary, Dev, and Beta Channels shortly.

[ADDED 5/30] As part of the Copilot experience’s evolution on Windows to become an app that is pinned to the taskbar, we are retiring the WIN + C keyboard shortcut. For new devices that ship with a Copilot key , this key will open Copilot. For existing devices without that key, using the WIN + (number position for Copilot pinned to your taskbar) is a great way to open Copilot.

Windows Insiders in the Release Preview Channel can install Windows 11, version 24H2 via our “seeker” experience in Windows Update. This means if you are an Insider currently in the Release Preview Channel on a PC that meets the Windows 11  hardware requirements , you can go to Settings and Windows Update and choose to download and install Windows 11, version 24H2 if you want. Once you update your PC to Windows 11, version 24H2, you will continue to automatically receive new servicing updates through Windows Update (the typical monthly update process). For instructions on how to join the Windows Insider Program and join your PC to the Release Preview Channel,  click here .

PLEASE NOTE: Windows Insiders in the Canary and Dev Channels will not be able to switch to the Release Preview Channel as they are on builds already based on Windows 11, version 24H2 but are on higher build numbers. These Insiders don’t need to switch. 

Commercial*** customers enrolled in the  Windows Insider Program for Business  can begin validating Windows 11, version 24H2 on PCs in their organizations. For these customers, the Windows 11, version 24H2 feature update is available through Windows Update for Business (WUfB) and Windows Server Update Service (WSUS). Azure Marketplace will be coming soon. You can learn more about deploying pre-release feature updates using  these deployment methods here . Should any issues arise, IT admins in organizations deploying Release Preview updates can request Microsoft Support .

And finally – ISOs are now available for download for Windows 11, version 24H2 via the Windows Insider ISO download page .

Thanks, Windows Insider Program Team

*Please note that Cortana, Tips, and WordPad are removed after upgrading to Windows 11, version 24H2. These apps are deprecated .

**Copilot in Windows is being rolled out gradually to Windows Insiders across our global markets. Customers in the European Economic Area will be able to download the Copilot in Windows experience as an app from the Microsoft Store (coming soon).

***We consider a device a commercial device if it is not running the Windows 11 Home edition AND is being managed by an IT administrator (whether via Microsoft Endpoint Manager or other management solution) or has a volume license key or commercial ID or is joined to a domain.

• Case Report
• Open access
• Published: 31 May 2024

Presentation and management of delayed bronchopleural fistula after pulmonary lobectomy: a case report

• Riad Abdel Jalil   ORCID: orcid.org/0000-0001-8018-6148 1 , 2 ,
• Ali Dabous 1 ,
• Almu’atasim Khamees   ORCID: orcid.org/0000-0002-6282-8351 1 ,
• Ahmad Yasin Alzu’bi 1 &
• Joud Al-Majali 1  

Journal of Cardiothoracic Surgery volume  19 , Article number:  311 ( 2024 ) Cite this article

39 Accesses

Metrics details

Lung cancer is the second most diagnosed cancer and the leading cause of cancer deaths worldwide. Surgical lung resection is the best treatment modality in the early stages of lung cancer as well as in some locally advanced cases. Postoperative air leak is one of the most common complications after pulmonary resection with incidence ranging between 20 and 33%. The majority of air leaks seal, within 5 days after surgery, on their own by conservative management. However, at least 5% of patients still have prolonged air coming out from the residual lung at discharge. This report describes the management of a thin lady with right lung cancer who underwent a right lower lobectomy and then suffered from a delayed air leak 7 weeks after surgery and required extensive thoracic and general surgery collaboration.

Case presentation

A 72-year-old heavy smoker female patient diagnosed with stage I lung cancer underwent right robotic-assisted thoracoscopic surgery converted to thoracotomy because of a fused fissure, right lower lobectomy, and mediastinal lymphadenectomy presented with delayed air leak 49 days after surgery. VATS decortication and mechanical pleurodesis were done 2 weeks after unsuccessful conservative treatment. Still, the lung failed to expand four weeks later so the patient was sent to surgery; she is underweight (BMI of 18) with not many options for a big flap to fill the chest cavity empty space. Accordingly; the decision was to use multiple pedicle flaps; omentum, intercostal muscle, and serratus anterior muscle to cover the bronchopleural fistulas and fill the pleural space in addition to mechanical and chemical pleurodesis. Full expansion of the lung was obtained. The patient was discharged on Post-Operative day 5 without remnant pneumothorax.

Conclusions

Air leaks After lobectomy usually presents directly postoperatively; various management options are available ranging from conservative and minimally invasive to major operative treatment. We presented what we believe was unusual delayed bronchopleural fistula post-lobectomy in a thin lady which demonstrates clearly how a delayed air leak was detected and how collaborative efforts were crucial for delivering high-quality, safe, and patient-centered care till treated and complete recovery.

Peer Review reports

Cancer is becoming more common, and with that comes a wide range of treatment options and complications; this proves the importance of a multidisciplinary team. Lung cancer is the second most diagnosed cancer worldwide (after breast cancer), and it is by far the leading cause of cancer deaths accounting for about 1.80 million deaths in 2020 [ 1 ]. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined [ 2 ].

Postoperative air leak is one of the most common complications after pulmonary resection and contributes to postoperative pain, complications, and increased hospital length of stay [ 3 ]. Several risk factors, including both patient and surgical characteristics, increase the frequency of air leaks [ 3 ]. Air leak rates have varied in the literature, but the largest series report a rate between 20 and 33% after elective pulmonary resection, with a majority of air leaks sealing on their own, within 5 days of surgery and are managed with tube thoracostomy and observation [ 4 ]. However, prolonged air leak (PAL) is considered if the leak present for more than five to seven days [ 5 ].

It has been reported that although specific techniques, intraoperative strategies, and dedicated devices are commonly used to prevent prolonged air leaks (PAL)—at least 5% of patients still present air coming out from the residual lung at discharge [ 6 ]. This report describes the management of a lady with right lung cancer that suffered from a delayed air leak and required extensive thoracic and general surgery collaboration. The case demonstrates clearly how a delayed air leak was detected and how collaborative efforts were crucial for delivering high-quality, safe, and patient-centered care.

A 72-year-old female patient, who has a prolonged history of diabetes mellitus type 2, hypertension, and was a heavy smoker of 50 pack-year, was accidentally found to have a 2 cm nodule in the right lung lower lobe. She was then referred to King Hussein Cancer Center (KHCC) for further investigation. A Positron Emission Tomography Computerized tomography (PET CT) scan was done and showed a peripherally located sub-solid cavitary lesion in the right lower lobe posteriorly measuring about 2.5 × 2 cm in maximum axial dimensions, with no evidence of other concerning hypermetabolic lesions. Computerized tomography (CT)-guided biopsy by interventional radiology was done and pathology examination showed well-differentiated adenocarcinoma with lepidic pattern. The staging was T1N0M0. The multidisciplinary committee (MDC) recommendation was to go with surgical intervention.

Normal preoperative routine labs with a pulmonary function test (PFT) resulted in FEV1 at 68% and DLCO at 95%. On the 19th of October 2022, the patient underwent right robotic-assisted thoracoscopic surgery (RATS), which showed difficulty in dissecting right fused pulmonary fissures. Accordingly, robotic surgery converted to anterolateral thoracotomy with right lower lobectomy and mediastinal lymphadenectomy. The pathology report showed completely resected 2.2 cm well-differentiated adenocarcinoma, and pathology staging was reported as pT2N0; due to visceral pleural invasion. Negative Lympho-Vascular Invasion (LVI).

The postoperative (post-op) course was smooth, she had one chest tube, the pain was controlled, and she used the incentive spirometer efficiently. Daily chest x-ray showed good right lung inflation. The chest tube was removed on postoperative day four and the patient was discharged home assuring compliance for incentive spirometer use. 49 days after the first surgery, she presented to the Thoracic surgery clinic with a 7-day history of shortness of breath, chest CT scan showed a new large right pneumothorax with a small dependent pleural fluid resulting in segmental pulmonary atelectasis. A suspicious focal connection between the right lower bronchus stump and pleural cavity was suspected suggesting a bronchopleural fistula (BPF).

The patient was admitted, and a pigtail chest drain was inserted right away and connected to the chest bottle on wall suction, around 200 ml of serosanguinous fluid was withdrawn at insertion with continuous air bubbling seen. On day 3 post-admission she was doing well, with no shortness of breath reported, vital signs were within normal limits, the pigtail drain was connected to the Heimlich valve, and the patient was discharged home. After one week of follow-up, a chest x-ray showed persistent right pneumothorax without improvement in the right lung inflation. Conservative treatment continued for another week but the chest x-ray didn’t show any changes. Accordingly, the thoracic surgery team decided to go for the right single-port VATS decortication and pleurodesis which was done utilizing a single-port VATS approach through the previous chest tube wound. After that, the patient was observed in the hospital for four weeks with not much improvement in lung expansion (Fig.  1 ). Bronchoscopy was done by the interventional pulmonary team in the hope to locate the bronchial fistula by occlusion of different sub-segments from the upper and middle lobes but couldn’t localize the fistula exactly, a glue was installed over the lower lobe stump site.

The patient’s chest x-ray before the third surgery

103 days after the first operation, the patient was sent to surgery again. because she is thin (Body Mass Index (BMI) is 18) and there are not many options for a big flap to fill the chest cavity empty space, we decided to use multiple flaps; the general surgery team performed laparoscopic surgery in which the greater omentum was transferred as a pedicle flap passing through an opening in the right hemi diaphragm anterior to the liver to the right chest cavity, this procedure was assessed by redo right VATS, which was converted to mini- anterolateral thoracotomy to extract the omentum. Pleural decortication and closure of multiple bronchopleural fistulas with an omental flap were done. Intercostal muscle and serratus muscle pedicle flaps were used to aid with pleural space-filling and BPF coverage in addition to mechanical and chemical pleurodesis. Full expansion of the lung was obtained.

The patient spent the night in the intermediate surgical unit and was transferred to the floor on the second-day post-op. She had two chest tubes; one anteriorly and the other posteriorly on the right side. She had a daily chest x-ray with good expansion and no air leak (Fig.  2 ). The post-op course was smooth, she was doing well without any signs of respiratory distress. On day 4 post-op the anterior chest tube was removed and there was no air leak, the posterior chest tube showed a slight air leak. On day 5 post-op there was no air leak, and the posterior chest tube was removed as well and the patient was discharged home. The patient was followed up in the thoracic surgery clinic, she was doing well, chest x-ray showed excellent right lung expansion without remnant pneumothorax. Also, there were no recurrent air leaks after a six-month (Fig.  3 ) and one-year follow-up.

Her chest x-ray after her third operation on postoperative day 1

Her follow-up chest x-ray after 6 months of the third operation

The use of robotic systems in healthcare and especially surgical procedures has rapidly increased in the last decade. This lady was the first patient to undergo a robotic-assisted lobectomy in Jordan. According to Yang et al., robotic-assisted thoracic surgery was advantageous in a case of lobectomy in a cancer patient with situs inversus totalis as it helped in identifying the anatomical abnormalities and facilitated the surgery [ 7 ]. In addition, Nomori et al. concluded that a largely fused fissure is not a limiting factor for the performance of VATS lobectomy [ 8 ]. While in our case it was challenging to complete the surgical procedure with fused pulmonary fissures and difficult dissection therefore the conversion to open lobectomy was mandatory.

Air leaks after elective pulmonary resection occur in approximately 28–60% of patients, with most of them resolving by postoperative day four [ 9 ]. Regarding air leaks occurring post-lobectomy, there was no case of delayed air leaks occurring more than a month after surgery in the literature review. The literature discussed prolonged persistent air leaks extensively, but none mentioned cases that were timely remote from surgery. Our patient complained of her first symptom of shortness of breath 49 days postoperatively despite having chest x-rays as an inpatient and outpatient during follow-up.

The management of air leaks varies from conservative by chest drain to chemical pleurodesis and surgical intervention. We attempted chest drain insertion and VATS decortication and pleurodesis without benefits. Thereafter bronchoscopy was done by the pulmonary team with the appliance of endobronchial glue. Despite this, the patient still suffered from a continuous right pleural hydro-pneumothorax. Although Kapicibasi & Baysungur proved a success rate of 80% in patients who underwent bronchopleural fistula repair using N-butyl cyanoacrylate by an endoscopic method [ 10 ].

Muscle flaps can be used in thoracic surgery to reconstruct the defect with well-vascularized tissue, space-filling, separate tissues in some cases, and closure of fistulas or stumps to prevent air or fluid leaks to the pleural space [ 11 ]. However, these flaps are not commonly used unless there is a unique issue [ 11 ].

Finally, the greater omentum was transferred as a pedicle flap passing through an opening in the right hemi diaphragm anterior to the liver to the right chest cavity, this procedure was assessed by redo right VATS, which was converted to mini-anterolateral thoracotomy to extract the omentum. Pleural decortication and closure of multiple bronchopleural fistulas with an omental flap were done. Intercostal muscle and serratus muscle pedicle flaps were used to aid with pleural space-filling and BPF coverage in addition to mechanical and chemical (Talc powder) pleurodesis. Full expansion of the lung was observed.

Woo et al. presented case series for 5 patients who had air leaks postoperatively, resulting from BPF, with failed prolonged conservative management. He used latissimus dorsi and serratus anterior muscles for fistula repair and closure of rib defect respectively [ 12 ]. Moreover, these dual flaps depend primarily on the muscle bulk, which was small in our case, who had below normal BMI. Accordingly, we use triple flaps for the closure of the BPF.

Air leaks post-lobectomy usually present directly postoperatively; various management options are available ranging from conservative and minimally invasive to major operative treatment. We presented what we believe was unusual delayed bronchopleural fistula post-lobectomy which demonstrates clearly how a delayed air leak was detected and how collaborative efforts were crucial for delivering high-quality, safe, and patient-centered care till treated and complete recovery.

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Abbreviations

King Hussein Cancer Center

Positron Emission Tomography

Computerized tomography

multidisciplinary committee

pulmonary function test

Lympho-Vascular Invasion

Video-assisted thoracoscopic surgery

postoperative

bronchopleural fistula

Body Mass Index

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Riad Abdel Jalil, Ali Dabous, Almu’atasim Khamees, Ahmad Yasin Alzu’bi & Joud Al-Majali

Department of Surgery, King Hussein Cancer Centre, Amman, Jordan

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R.A.J.: Case report design, patient medical and surgical care, and revised the final manuscript.A.D.: Patient medical and surgical care, and revised the final manuscript.A.K.: Case report design, wrote the initial draft of the case report, and revised the final manuscript.A.Y.A.: Wrote the initial draft of the case report.J.A.: Wrote the initial draft of the case report.

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Jalil, R.A., Dabous, A., Khamees, A. et al. Presentation and management of delayed bronchopleural fistula after pulmonary lobectomy: a case report. J Cardiothorac Surg 19 , 311 (2024). https://doi.org/10.1186/s13019-024-02795-8

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Received : 21 August 2023

Accepted : 18 February 2024

Published : 31 May 2024

DOI : https://doi.org/10.1186/s13019-024-02795-8

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