Endobronchial spigot occlusion for grade IV tuberculosis-associated persistent bronchopleural fistula

A male in his late teens presented with acute respiratory distress, subcutaneous emphysema and a pneumothorax in the setting of necrotising pulmonary tuberculosis. Imaging demonstrated a thick-walled cavitary lesion in the right upper lung with direct communication to the pleural space, consistent with a severe bronchopleural fistula (BPF) causing continuous air leak and loss of effective ventilation. Despite intercostal drainage, antimicrobial therapy and lung-protective ventilation, the patient's condition deteriorated due to persistent ventilatory compromise. Bronchoscopic evaluation identified a mural defect in the right main bronchus. A silicone endobronchial spigot was deployed as an endoluminal patch, resulting in immediate cessation of the air leak, improved respiratory mechanics and clinical improvement. The patient remained stable on antitubercular therapy with no recurrence of the leak at follow-up. This case highlights the value of bronchoscopic spigot occlusion as a practical and minimally invasive solution for central BPF in critically ill patients.