CRA100 MANAGEMENT OF BRONCHOPLEURAL FISTULA SECONDARY TO PULMONARY TUBERCULOSIS PRESENTING WITH PERSISTENT PNEUMOTHORAX
Nadia Ventiani1, Oea Khairsyaf2, Rusilawati1, Nina eristiana3, Achmad Peter Syarief3
1Departement of Pulmonology and Respiratory Medicine, Faculty of Medicine,Andalas University, Padang West Sumatra, Indonesia
2Departement of Pulmonology and Respiratory Medicine, Dr. M. Djamil General Hospital, Padang, West Sumatra, Indonesia
3Departement of Pulmonology and Respiratory Medicine, Dr. H. A. Rotinsulu Lung Hospital, Bandung, West Java, Indonesia
Introduction
Bronchopleural fistula is a serious and potentially fatal complication of pulmonary tuberculosis, characterized by persistent air leakage. Early diagnosis through accurate localization of the fistula is essential to guide appropriate management. Prompt intervention and effective closure are crucial to prevent serious complications
Case Report
A 43-year-old male presented with sepsis and respiratory failure due to persistent pneumothorax despite chest tube placement for 21 days. GeneXpert MTB/RIF confirmed Mycobacterium tuberculosis with rifampicin sensitivity. He had a history of pneumomediastinum following mechanical ventilation. Flexible bronchoscopy identified a bronchopleural fistula measuring 1–1.5 cm at the right second carina. The patient received broad-spectrum antibiotics and underwent surgical repair with fistulorrhaphy. Postoperative evaluation with flexible bronchoscopy showed complete closure of the fistula, and chest radiograph confirmed full lung re-expansion.
Discussion
Bronchopleural fistula is a serious and potentially fatal complication of pulmonary tuberculosis, commonly presenting as persistent pneumothorax. It increases the risk of infection such as empyema or sepsis, particularly in immunocompromised patients. Flexible bronchoscopy is the key modality for confirming the diagnosis through direct fistula visualization. In this case, fistulorrhaphy was performed as definitive management due to a 1–1.5 cm fistula located at the right second carina.
Conclusion
Persistent pneumothorax is a key clinical indicator of bronchopleural fistula. Flexible bronchoscopy is the primary modality for confirmation and localization. Fistula closure techniques should be selected based on the size and anatomical location of the defect.