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• W4387293887 abstract "SESSION TITLE: Lung Pathology Case Report Posters 17 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Bronchopleural fistula may result as a postoperative complication of pneumectomy or lobectomy, or following chemo-radiotherapy, pulmonary infection, or inflammatory reactions in the lung. We report a case of bronchopleural fistula developing within a month of smoke inhalational injury, which is a rare etiology and has not been reported before to the best of our knowledge. CASE PRESENTATION: A young 23-year-old man was admitted to the hospital for severe burns; the patient was using propane heater to heat the tent that he was sleeping in while camping, when he lit a cigarette which resulted in an explosion. He sustained significant burns all over his body and had to be mechanically ventilated for 21 days. His initial bronchoscopy on the day of admission showed inhalational injury with erythema of the distal trachea and large airways, in addition to friable, injured mucosa over the right mainstem and right lower lobe. He was treated with cefepime for his pneumonia. Following his discharge, he was transferred to a rehabilitation unit for continuation of care, but he had to be re-admitted for mild fever and persistent cough for one week, which was very productive with foul smelling sputum and bad taste. A chest x-ray performed at this time revealed air-fluid level in the right lung concerning for a cavitation. Subsequently, a CT scan showed small to moderate-sized loculated complex concerning for right hydro-pneumothorax with pleural thickening, and it showed two areas that appeared to be connected to the cavity raising strong suspicion for bronchopleural fistula (figure 1). Bronchoscopy revealed copious amounts of yellow-green mucus in the trachea; the superior segment of the right lower lobe was hypertrophic and significantly inflamed, and the scope could not be passed beyond the segmental bronchi level. There was copious secretions and mucus coming from the superior segment of the right lower lobe which is likely where this fistula was. A chest tube was placed for his hydro-pneumothorax and there was evidence of air leak further confirming the suspicion of a bronchopleural fistula. He was treated with vancomycin, cefepime and metronidazole for possible necrotizing pneumonia. Intrapleural vancomycin was given in preparation for a surgery. Thoracic surgery performed a right lower lobectomy, which he tolerated well, and he was continued on antibiotics for 3 more weeks. DISCUSSION: Bronchopleural fistula may be challenging to diagnose if the tract is not visualized radiologically or through bronchoscopy. However, the constellation of symptoms, signs, and the evidence of fluid filled loculated cavity in the lungs, further corroborated by air leak through chest tube can help establish the diagnosis. The reported mortality of bronchopleural fistula is as high as 71% (1). Patients presenting with bronchopleural fistula can be managed initially with medical treatment including drainage through chest tube, antibiotic treatment, and if needed, ventilator management, ultimately followed by surgery. CONCLUSIONS: Burn and smoke inhalation injuries may result in bronchopleural fistula formation, and due to its high mortality, early identification and definitive treatment with surgery can improve the prognosis. REFERENCE #1: Smolle-Juttner F, Beuster W, Pinter H. et al. Open-window thoracostomy in pleural empyema. Eur J Cardiothorac Surg 1992; 6: 635-8 DISCLOSURES: No relevant relationships by Brandon Hooks No relevant relationships by Ibrahim Zahid" @default.
• W4387293887 created "2023-10-03" @default.
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• W4387293887 date "2023-10-01" @default.
• W4387293887 modified "2023-10-07" @default.
• W4387293887 title "BRONCHOPLEURAL FISTULA SECONDARY TO SMOKE INHALATION INJURY: A RARE ETIOLOGY" @default.
• W4387293887 doi "https://doi.org/10.1016/j.chest.2023.07.3067" @default.
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