Bronchopleural Fistula Following Lobectomy after Prior Thoracic Endovascular Aortic Repair: A Case Report

Bronchopleural fistula (BPF) is a severe complication of lung cancer surgery that is often associated with impaired blood supply and poor healing. Thoracic aortic aneurysms (TAA) frequently coexist with lung cancer owing to their shared risk factors, and thoracic endovascular aortic repair (TEVAR) may further increase the risk of BPF by compromising bronchial artery blood flow.

A 72-year-old male with a history of cerebral infarction, hypertension, and a 4.8 cm TAA was incidentally found to have a 1.4 cm pulmonary nodule in the right lower lobe. Staged treatment was planned using TEVAR, followed by right lower lobectomy. TEVAR was performed successfully, and 48 days later, lobectomy confirmed stage IB large-cell carcinoma. On POD 27, the patient developed fever and dyspnea. CT revealed BPF, which was likely due to reduced bronchial blood flow after TEVAR. Chest tube drainage and an open-window thoracostomy were performed. Eight months later, thoracoplasty was performed using a muscle flap and omentopexy. The patient recovered completely and remained recurrence-free for 2 years.

This case underscores the importance of careful planning and surgical strategies to prevent BPF in patients with concomitant lung cancer and TAA. Early recognition of risk factors, including TEVAR-related bronchial ischemia, is crucial for optimizing outcomes.