Spontaneous Closure of Bronchopleural Fistula after Right Upper Lobectomy without Invasive Interventions-A Case...

A bronchopleural fistula (BPF) is a serious and potentially life-threatening complication of pulmonary resection, with a particularly high incidence following pneumonectomy. Although surgical repair is the mainstay of treatment, conservative management with bronchoscopic intervention also results in complete resolution in some cases. Spontaneous closure of the BPF, especially after full dehiscence of the bronchial stump, remains exceptionally uncommon.

A 60-year-old man with diabetes mellitus and interstitial pneumonia underwent right upper lobectomy for suspected lung cancer. The tumor adhered to the superior vena cava, requiring pericardial dissection and phrenic nerve resection. The bronchial stump was sutured and covered with a free pericardial fat pad. Postoperative recovery was initially uneventful; however, on POD 18, the patient presented with dyspnea and was diagnosed with right lower lobe pneumonia. On POD 31, he spat out all suture material and fat tissue with hemosputum. Imaging findings confirmed the presence of a BPF at the bronchial stump without pneumothorax or empyema. He was then conservatively managed with antibiotics and glycemic control. The hilar air space gradually decreased over the following weeks, and CT confirmed complete spontaneous closure of the fistula by POD 151.

Our case highlights that, under selected conditions-such as absence of empyema, confined necrosis of the bronchial stump, and reduced residual pleural space due to phrenic nerve paralysis and adhesions surrounding the hilum-spontaneous closure of a BPF without a surgical or bronchoscopic intervention is possible. Conservative management with careful monitoring may be a feasible option in selected patients.