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. 2025 Mar 20;13(3):e70134.
doi: 10.1002/rcr2.70134. eCollection 2025 Mar.

Bronchopleural Fistula Following COVID-19 and Necrotizing Pneumonia in Childhood: Treatment With Intrapleural Vacuum-Assisted Closure Therapy

Jose Carlos Fraga  1 , Felipe Colombo Holanda  2 , Natalia Zanini Silva  3 , Maria Fernanda Oliveira  4 , Paola Santis Isolan  5 , Elenara Fonseca Procianoy  6
Affiliations

Bronchopleural Fistula Following COVID-19 and Necrotizing Pneumonia in Childhood: Treatment With Intrapleural Vacuum-Assisted Closure Therapy

Jose Carlos Fraga et al. Respirol Case Rep. .

Abstract

Bronchopleural fistula is an abnormal communication between the bronchial tree and the pleural space. Necrotizing pneumonia is a catastrophic infection of the lungs characterised by necrosis of the interstitial tissue. Although rarely reported, it has been described as a complication of COVID-19. The usual treatment for bronchopleural fistula involves endoscopic or surgical procedures. We present the case of a 5-year-old girl admitted with necrotizing pneumonia and difficult-to-control bronchopleural fistula, with a report of flu-like illness and a positive PCR test for COVID-19 2 months earlier. Over 38 days, several procedures were performed, including left-side tube drainage, thoracotomy, segmental resection, open window thoracotomy, and finally vacuum-assisted closure (VAC) therapy. Twenty days after the start of VAC therapy, complete closure of the bronchopleural fistula was achieved. At 26 months of follow-up, the child remained asymptomatic, with radiological examinations showing pulmonary expansion and absence of intrapleural air.

Keywords: COVID‐19 infection; bronchopleural fistula; children; necrotizing pneumonia; vacuum‐assisted closure therapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Sponge covered with a non‐adhering dressing (Adaptic) before introduction into the pleural space through OWT.
FIGURE 2
FIGURE 2
Timeline of BPF closure. OWT, open‐window thoracotomy; BPF, bronchopleural fistula.
See this image and copyright information in PMC

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