Abstract Introduction Bronchopleural fistulas (BPF) are pathological connections between the bronchial tree and the pleural space. It is an uncommon but often associated complication of lung resection and is not well described in the pediatric population. Diagnosis is usually dependent on imaging to visualize the mucosal defect. Visualization may be difficult due to fistula size, local inflammation, and post-surgical changes. BPF may not spontaneously close and can have significant morbidity. Case Discussion We present a 17-year-old male status post motor vehicle accident with resulting C3-T2 spinal cord injury, right lower lobe lobectomy (RLL) due to pseudomonal pneumonia and abscess, and chronic respiratory failure with tracheostomy and ventilator dependence. After his initial injury and hospitalization at an outside hospital (OSH), he was discharged to an acute rehabilitation facility near our children’s hospital. His OSH course was notable for recurrent bronchoscopies needed to maintain airway clearance despite frequent cough assist (CAD) and ventilation. After transferring, he required 3 additional bronchoscopies due to RLL mucus plugging versus pneumonia. After the 3rdbronchoscopy, CT chest demonstrated concern for RLL BPF from incomplete prior lobectomy versus abscess. Pediatric surgery and IR were consulted with a chest tube subsequently placed in RLL cavity. Given clinical improvement, his chest tube was removed and definitive surgical intervention was deferred. 6 months post transfer, he presented to us with recurrent fevers, abdominal pain, and increased tracheal secretions. Repeat CT showed an increased collection of fluid and gas at partial RLL lobectomy site. He was admitted and started on meropenum. Right chest tube was placed with drainage of purulent material. After worsening lung compliance requiring maximum ventilation pressures, bronchoscopy revealed an overt BPF at the anterior medial segment of the RLL, not seen on prior bronchoscopies. Copious purulent material was suctioned from the airways and pleural space. Chest tube cultures were positive for oral anaerobes (prevotella and fusobacterium species) in addition to candida galbrata treated with meropenum and micafungin for 14 days. Discussion/Conclusion Additional consultations were obtained with thoracic surgery and adult interventional pulmonologists. Surgical evaluations concluded that maintaining closure at RLL site was unlikely given continued ventilatory support needs. Patient currently has chest tube with ongoing discussions with interventional pulmonology regarding endobronchial valve placement pending resolution of chest tube drainage. This case highlights the importance of prompt identification of bronchopleural fistula while exploring the clinical course of patients without surgical interventions. This abstract is funded by: None
Lam et al. (Fri,) studied this question.