(1) SHP is a rare clinical entity that can lead to potentially life-threatening complications. (2) Early thoracotomy should be considered once the diagnosis of SHP is confirmed.

1. The management of late large PBPF can be only surgical. 2. Fibrothorax and empyema makes the approach through thoracotomy impossible and dangerous for dissection and repair. 3. Bronchial stump repair through the transpericardial approach by median sternotomy is very effective in late PBPF cases where the patient's general condition is good, allowing a major intervention.