Young patient with pneumonia complicated by bronchopleural fistula

We present the case of a 19 year old female presenting to the Emergency Department with signs of pneumonia and sepsis, with her clinical status deteriorating rapidly to septic shock and respiratory failure. Her pneumonia was complicated by formation of an empyema and a bronchopleural fistula. Bronchopleural fistula (BPF) is a fistula between pleural space and a bronchus. It is an uncommon complication of lung surgery, endobronchial interventions or chest trauma. They are sometimes formed secondary to postoperative pneumonia. Management of BPF requires surgical or bronchoscopic intervention with supportive care. Since a BPF can cause physiological tension pneumothorax, it can lead to significant worsening of respiratory status of these patients. Ventilator settings need to be adjusted to reduce the Positive end expiratory pressure and tidal volume to support these patients. With this case we highlight the importance of recognizing and diagnosing a BPF and timely management of a BPF in the emergency setting to help patients get to the definitive treatment of the fistula.