Broncho-pleuropericardial fistula complicating staphylococcal sepsis

Abstract

This is a rare case of broncho-pleuropericardial fistula in a 12-year-old female who presented with fever, painful joint swelling, and pleural and pericardial effusion secondary to disseminated methicillin-sensitive Staphylococcus aureus infection. The pleural and pericardial effusion were drained, however, air leak was observed from both tubes and was synchronous with mechanical inspiration. A broncho-pleuropericardial fistula was suspected and confirmed with computed tomography. This case report demonstrated that disseminated S. aureus bacteremia could result in broncho-pleuropericardial fistula. The ability of disseminated staphylococcal infection to produce pnemopericardium should be added to the list of other complications associated with disseminated staphylococcal sepsis.

Keywords: Bronchial fistula; fistula; pericardial tamponade; staphylococcal infections.

Figure 1

Scout image of the chest showing right pneumothorax, pneumopericardium, and a pig-tail catheter overlying the right cardiac border

Figure 2

Axial image of the lower chest (lung window) showing moderate size right hydropneumothorax and pneumopericardium with the tip of the pig-tail catheter located in the anterior pericardial cavity

Figure 3

Image obtained post-contrast injection through the pig-tail catheter that demonstrated accumulation of the contrast within the pericardial and right pleural cavity