Bronchopleural fistula (BPF) is a sinus tract between the bronchus and the pleural space that may result from a necrotizing pneumonia/ empyema (anaerobic, pyogenic, tuberculous and fungal), lung neoplasm, blunt and penetrating injuries, or may occur as a complication of procedures, such as lung biopsy, chest tube drainage, thoracocentesis or may complicate radiation therapy. Clinically it is suspected when the air leak through the underwater drainage system persists beyond 24 hours of its initiation. Mortality rates vary between 18% and 67%. The management of BPF is one of the most complex challenges encountered by the chest physicians.
A 52 year old male presented to our emergency department with the chief complaint of breathlessness. The patient was a known case of bronchial asthma with allergic bronchopulmonary aspergillosis (ABPA) and bilateral bronchiectasis. The CT scan showed bilateral pneumothorax, more on the left side. Both the lungs were cystically dilated with areas of consolidation.