Spontaneous Closure of Bronchopleural Fistula Following Anti-tuberculous Treatment

Ganesh Kasinathan^1, and Naganathan Pillai²

¹Department of Internal Medicine, Segamat Hospital, Johor, Malaysia

²Department of Internal Medicine, Monash University Malaysia, Bandar Sunway, Malaysia

Cite this paper

Ganesh Kasinathan and Naganathan Pillai. Spontaneous Closure of Bronchopleural Fistula Following Anti-tuberculous Treatment. American Journal of Medical Case Reports. 2017; 5(9):242-243. doi: 10.12691/AJMCR-5-9-4

Abstract

This case report highlights a 55 year old gentleman of Malay descent who presented to the hospital with chronic cough, dyspnoea and night sweats. He is a chronic smoker and works in a rubber plantation. On examination, he was tachypnoeic and tachycardia, febrile and in type 1 respiratory failure. Physical examination was consistent with a right sided spontaneous pneumothorax which was confirmed on a chest radiograph. The chest radiograph also showed evidence of active tuberculosis involving the right upper and middle lobes. His sputum samples smear and culture revealed Mycobacterium tuberculosis complex. He was immediately placed on an intercostal drain with air leak persisting after two weeks. A high resolution CT scan of the thorax showed a bronchopleural fistula measuring 7 mm in diameter in the anterior segment of the right lower lobe. With careful management of the chest drain and early administration of antituberculous chemotherapy, the air leak ceased and the repeated CT scan of the thorax showed obliteration of the fistula. He continued to improve and currently on the 5^th month of treatment. Conclusion: An underlying tuberculosis infection resulting in a bronchopleural fistula should not be missed in a patient from a tuberculous endemic area. Effective careful management of the chest drain and early administration of antituberculous treatment are vital to facilitate the healing of a bronchopleural fistula.

Keywords

tuberculosis, bronchopleural fistula, chest drain, pneumothorax

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest. 2005; 128 (6): 3955-65.
[2]	Westcott JL, Volpe JP. Peripheral bronchopleural fistula: CT evaluation in 20 patients with pneumonia, empyema, or postoperative air leak. Radiology. 1995; 196: 175-81.
[3]	Matthew TL, Spotnitz WD, Kron IL, Daniel TM, Tribble CG, Nolan SP. Four years’ experience with fibrin sealant in thoracic and cardiovascular surgery. Ann ThoracSurg1990; 50: 40-43; discussion 43-44.
[4]	Pairolero PC, Arnold PG, Trastek VF, Meland NB, Kay PP. Postpneumonectomy empyema: The role of intrathoracic muscle transposition. J Thorac Cardiovasc Surg 1990; 99: 958-66; discussion 966-8.
[5]	Zhang J, Hu S, Gao B, Liu D, Song F, Li B, et al. Interventional closure of postpneumonectomy bronchial pleural fistula with a self-expandable double umbrellashapedoccluder knitted with nitinol shape memory alloy. J Thorac Cardiovasc Surg 2007; 134: 531-33.