Spontaneous Pneumothorax Following Bronchopleural Fistula In Geriatric Patient: A Case Report And Emergency Management

Abstract

Introduction: Bronchopleural fistula (BPF) is a pathological connection between the
bronchial tree and the pleural space. Clinical manifestation of BPF may be classified as acute,
subacute, and delayed or chronic forms. Acute BPF can be a life-threatening condition due to
tension pneumothorax or asphyxiation from pulmonary flooding.
Purpose: To report the patient survival from the upper lobe of the right lung bronchopleural
fistula wedge resection and to use staplers as upper lobe pulmonary wound closure.
Case Report: 72-year-old male referred from pulmonologist with a chief complaint of
progressive shortness of breath and nonproductive cough for four days. The patient had a
history of tuberculosis and COPD and a heavy smoker for the last 50 years. Chest
radiography showed a decreased opacity of the right hemithorax, with 40% collapsed of the
lung parenchyma. Chest tube insertion performed on the right hemithorax, then the patient
got immediate relief. On the seventh day, the patient complained of worsening dyspnea. A
chest x-ray showed lung collapsed on the right hemithorax. Multislice CT-scan (MSCT) of
the chest showed right-sided pneumothorax with bronchopleural fistula. Wedge resection for
the 3 cm in diameter fistula was performed. On the seventh day postoperative, the patient was
fully recovered then discharged from the hospital.
Conclusion: Seven days postoperatively of wedge resection, the patient discharge from the
hospital without any complication and stable hemodynamic. The patient went to the
outpatient department for follow up one week after.