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Bronchopulmonary Fistula Development in an Elderly Male With COVID-19 Infection
Aldin Malkoc1,2, Harpreet Gill1,2, Natalie Liu1,3
1Department of General Surgery, Arrowhead Regional Medical Center, Colton, USA.
Abstract:
COVID-19 pneumonia can cause a wide range of complications including pneumothorax and empyema. However, in severe cases, it can lead to bronchopulmonary fistula (BPF) formation and a persistent air leak due to a connection between the pleural space and the bronchial tree. We report the case of a 77-year-old man with a history of hypertension, who presented to the emergency department for evaluation of dyspnea. Admission labs were significant for a positive rapid antigen SARS-Cov-2 test and elevated troponin I. A chest x-ray demonstrated patchy interstitial opacification and ground glass appearance bilaterally. Within the first 24 hours of presentation, the patient developed a right-sided spontaneous pneumothorax and had a 14 French pigtail catheter placed. The patient subsequently developed a persistent air leak after chest tube placement and required video-assisted thoracoscopic surgery (VATS) with talc pleurodesis and a 32 French chest tube placement. In this unique case, we describe an elderly patient's experience of bronchopulmonary fistula formation as a complication of COVID-19 pneumonia and the successful management of this complication with VATS.
Insights
Severe COVID-19 pneumonia can lead to bronchopulmonary fistula (BPF), a persistent air leak. This case highlights successful management of BPF in an elderly patient using video-assisted thoracoscopic surgery (VATS).
Area of Science:
- Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- COVID-19 pneumonia presents diverse complications, including pneumothorax and empyema.
- Severe cases can result in bronchopulmonary fistula (BPF), characterized by a persistent air leak between the pleural space and bronchial tree.
Observation:
- A 77-year-old male with hypertension presented with dyspnea and tested positive for SARS-CoV-2.
- Initial chest X-ray revealed bilateral interstitial opacification and ground-glass appearance.
- The patient developed spontaneous pneumothorax within 24 hours, requiring catheter placement, followed by a persistent air leak.
Findings:
- The patient developed a bronchopulmonary fistula as a complication of COVID-19 pneumonia.
- Management involved video-assisted thoracoscopic surgery (VATS) with talc pleurodesis and chest tube placement.
Implications:
- This case underscores the potential for BPF formation in severe COVID-19 pneumonia, even in elderly patients.
- Successful surgical intervention with VATS offers a viable treatment option for managing this rare but serious complication.
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