Successful surgical treatment of bronchopleural fistula caused by severe pulmonary tuberculosis: A case report and review of literature

Abstract

BACKGROUND Bronchopleural fistula (BPF) is a relatively rare, but severe complication of pulmonary tuberculosis. It is associated with significant mortality; however, its management remains a major therapeutic challenge. CASE SUMMARY We present a 24-year-old man with BPF resulting from severe pulmonary tuberculosis combined with mixed infections. The damaged right upper lobe and concomitant empyema were demonstrated via computed tomography. After undergoing open-window thoracostomy and tuberculosis treatment for 4 mo, decortication and right upper lobectomy were subsequently performed, leading to the resolution of tuberculosis and other concurrent pulmonary infections. Follow-up, 6 mo after surgery, failed to reveal any evidence of infection recurrence resulting in a good prognosis. CONCLUSION The disease course of tuberculous BPF is particularly challenging. Surgical intervention serves as an effective and safe therapeutic strategy for BPF.

Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease

“…Tuberculous BPF is rare and often a diagnostic challenge due to its subtle and indolent presentation. 11,14 Symptoms range from overt to covert, and include productive cough, subcutaneous emphysema, fever, sudden dyspnea, low oxygen saturation, low blood pressure and pneumothorax. 17 Due to its rarity, a BPF can be a diagnostic conundrum.…”

“… 4 , 7 - 9 Nonsurgical causes of include infections, neoplastic lesions, trauma, and chemoradiation. 10 - 15 Complications from BPF include contamination of the pleural space, causing inflammation and empyema. This can lead to reduced lung expansion and repeated pneumonia of the opposite lung due to aspiration of the contaminated pleural fluid.…”