Management of acquired bronchopleural fistula due to chemical pneumonia

Reddy Ravikanth^a*, Sunil Mathew^b, Denver Steven Pinto^a

^aDepartment of Radiology, St. John’s Medical College, Bengaluru, Karnataka, India, ^bDepartment of Anatomy, St. John’s Medical College, Bengaluru, Karnataka, India

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

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, Contrast‑enhanced computed tomography, Chemical pneumonia, Pleurocutaneous tract