Year: 2025
Type: article
Study design: Case Report
Abstract: Case PresentationA 62-year-old male, a chronic smoker, presented to the Emergency Department (ED) with complaints of cough, mucoid expectoration and MMRC grade III dyspnea worsening over the past 2 days.He had a history of weight loss over 10 kg in past 1 month.There was no history of tuberculosis (TB), malignancy, or any significant past history.On arrival, the patient had stable vitals and a room air saturation of 80%, which increased to 98% with supplemental oxygen at 6 L/min via face mask.Chest auscultation revealed decreased breath sounds over the right side.Blood investigations revealed an Hb of 11.8 gm/dL, WBC count of 43.2 × 10 3 /cmm, pH of 7.38, and a lactate level was 3.2 mmol/L. DiagnosisHydropneumothorax with bronchopleural fistula: Chest X-ray showed right hydropneumothorax (Fig. 1).A 24F intercostal drainage tube was inserted in the 5th intercostal space.Dyspnea improved but air was seen to bubble continuously in underwater chamber.A contrast-enhanced computed tomography (CECT) chest revealed consolidation and fibrobronchiectatic changes in right middle lobe with a cavitatory lesion that had ruptured into the pleura creating bronchopleural fistula and secondary hydropneumothorax (Fig. 2).Pulmonary medicine consultation was sought; the patient's further stay in the ED was uneventful. Key Educational TakeawaysBronchopleural fistula is a pathological tract between bronchus and pleural cavity.It carries high mortality and morbidity, diagnosis is difficult and despite advancements, therapeutic options are limited.1,2 Diagnosis can be missed by emergency physicians if the index of suspicion is low or a persistent air leak is not captured.More than two-thirds of cases are related to some surgical procedure, others are due to conditions like TB, necrotizing pneumonia, or are iatrogenic.3 Chest X-ray is the initial
Authors: Prakash R Mishra, Abhiraj Raveendran
Institution: All India Institute of Medical Sciences
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7117870123