Bronchopulmonary Fistula Development in an Elderly Male With COVID-19 Infection

Abstract

COVID-19 pneumonia can cause a wide range of complications including pneumothorax and empyema. However, in severe cases, it can lead to bronchopulmonary fistula (BPF) formation and a persistent air leak due to a connection between the pleural space and the bronchial tree. We report the case of a 77-year-old man with a history of hypertension, who presented to the emergency department for evaluation of dyspnea. Admission labs were significant for a positive rapid antigen SARS-Cov-2 test and elevated troponin I. A chest x-ray demonstrated patchy interstitial opacification and ground glass appearance bilaterally. Within the first 24 hours of presentation, the patient developed a right-sided spontaneous pneumothorax and had a 14 French pigtail catheter placed. The patient subsequently developed a persistent air leak after chest tube placement and required video-assisted thoracoscopic surgery (VATS) with talc pleurodesis and a 32 French chest tube placement. In this unique case, we describe an elderly patient's experience of bronchopulmonary fistula formation as a complication of COVID-19 pneumonia and the successful management of this complication with VATS.

Mast cell degranulation-triggered by SARS-CoV-2 induces tracheal-bronchial epithelial inflammation and injury

“…SARS-CoV-2 replication leads to a rapid loss of the ciliary layer and impairs mucociliary clearance in a reconstructed human bronchial epithelium model ( Robinot et al., 2021 ). Pathological phenomena, such as open intrapulmonary bronchopulmonary anastomoses, bronchial arteries enlargement, bronchopulmonary fistula and airway fibrin cast obstruction have been identified in COVID-19 patients ( Barral et al., 2020 ; Galambos et al., 2021 ; Malkoc et al., 2022 ; Bodmer et al., 2023 ). Uncovering these virus-host interactions and induction of inflammation in the trachea-bronchia regions helps to understand viral spread and pathogenesis.…”