Bronchopleural fistula secondary to spontaneous pneumothorax due to bullous disease: case report

Abstract

Bullous lung disease is a variant of emphysema characterized by the formation of air cavities larger than 1 cm, primarily associated with COPD and chronic smoking. Its complications include spontaneous pneumothorax, hemoptysis, bulla infection, and bronchopleural fistula, the latter of which is difficult to manage clinically and carries a high morbidity and mortality rate. Spontaneous pneumothorax secondary to bullous disease can be complicated by bronchopleural fistula, a rare condition outside of surgery. Persistent air leak limits conservative management and requires consideration of surgery. Video-assisted thoracoscopy and limited lung resections are effective and safe options, improving prognosis and respiratory function in selected patients. Furthermore, bronchopleural fistula secondary to spontaneous pneumothorax due to bullous disease is a rare but serious complication. Timely diagnosis and adequate surgical approach are crucial for clinical recovery and reduced morbidity and mortality in these patients. We present the case of a 63-year-old male patient with a history of COPD and chronic smoking who was admitted with a left pneumothorax initially managed with closed thoracostomy. He presented with a persistent air leak secondary to severe bullous emphysema. Due to the lack of resolution with conservative management, surgery was performed, revealing a ruptured apical bulla with a bronchopleural fistula, fibrinopurulent pleural effusion, and lung entrapment. A non-anatomical segmentectomy was performed with closure of the fistula. The postoperative outcome was favorable, and the patient was discharged on the fourth day without complications.