Development of Bronchopleural Fistula Complicated by Empyema Fifteen Years After Right Lower Lobe Lobectomy: A Case Report

Patient: Male, 55-year-old Final Diagnosis: Bronchopleural fistula • empyema Symptoms: Back pain • productive cough • shortness of breath Medication:— Clinical Procedure: Bronchoscopy • chest wall resection • laparotomy • omentectomy • thoracentesis • thoracotomy Specialty: Microbiology and Virology • Pulmonology • Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Bronchopleural fistula formation is a rare complication of lobectomy surgery, with a frequency reported ranging from 0.5% to 1%. A post-lobectomy bronchopleural fistula usually presents within 14 days of surgery. To our knowledge, it is extremely rare for a bronchopleural fistula to develop many years after an operation. CASE REPORT: We present the case of a 55-year-old male smoker with history of a right lower lobe lobectomy 15 years prior who presented to the Emergency Department with complaints of worsening back pain, shortness of breath, and cough productive of sputum. He was found to have a right bronchopleural fistula with right-sided empyema. He was taken to the operating room a few days after initial admission for right thoracoscopic chest exploration, right chest debridement, right chest wall resection, and window procedure with creation of pleuro-cutaneous fistula. Ultimately, he required a right completion pneumonectomy and buttress of bronchial stump with transdiaphragmatic omental flap. CONCLUSIONS: We diagnosed a rare case of post-lobectomy bronchopleural fistula complicated by an empyema that demonstrates bronchopleural fistulas can appear 15 years postoperatively and present with subacute clinical signs and symptoms.