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Case Reports
. 2018 Apr-Jun;30(2):116-118.
doi: 10.4103/tcmj.tcmj_98_17.

Management of acquired bronchopleural fistula due to chemical pneumonia

Reddy Ravikanth  1 , Sunil Mathew  2 , Denver Steven Pinto  1
Affiliations
Case Reports

Management of acquired bronchopleural fistula due to chemical pneumonia

Reddy Ravikanth et al. Tzu Chi Med J. 2018 Apr-Jun.

Abstract

Bronchopleural fistula (BPF) is a sinus tract between the bronchus and the pleural space that may result from a necrotizing pneumonia/empyema (anaerobic, pyogenic, tuberculous, or fungal), lung neoplasms, and blunt and penetrating lung injuries or may occur as a complication of procedures such as lung biopsy, chest tube drainage, thoracocentesis, or radiation therapy. The diagnosis and management of BPF remain a major therapeutic challenge for clinicians, and the lesion is associated with significant morbidity and mortality. Here, we present a 70-year-old male with acquired BPF due to chemical pneumonitis caused by aspiration of kerosene who presented with the symptoms of fever, cough with expectoration, breathlessness and signs of tachycardia, tachypnea, diminished breath sounds, and crepitations. After a 3-week course of culture-sensitive antibiotics with β-lactam and β-lactamase inhibitors, open drainage of the empyema was done following which the patient showed symptomatic improvement and was discharged.

Keywords: Acute respiratory distress syndrome; Bronchopleural fistula; Chemical pneumonia; Contrast-enhanced computed tomography; Pleurocutaneous tract.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Frontal chest radiograph shows volume loss with an air fluid level in the right retrocardiac region (arrow). There is also right costophrenic angle blunting (asterisk) with thickening of the right minor fissure
Figure 2
Figure 2
Bronchogram demonstrating a bronchopleural fistula (top arrow) between the right lower bronchus and pleura with contrast pooling in the pleural cavity (bottom arrow)
Figure 3
Figure 3
(a) Coronal contrast-enhanced computed tomography section of the chest showing an encysted pleural collection with right-sided pleural effusion (asterisk). (b) Coronal contrast-enhanced computed tomography section of the chest in the lung window showing the posterior basal subsegmental bronchus leading into the collection (arrows)
Figure 4
Figure 4
8 weeks after discharge, fluoroscopy performed after injection of contrast material into the airway via bronchoscope shows no extravasation of contrast material in the pleural space, suggesting obliteration of the bronchopleural fistula
See this image and copyright information in PMC

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