Left pyopneumothorax with bronchopleural fistula and closure

A 75 year old elderly male came to our OPD with chief complaints of breathlessness, cough with expectoration for 1 month and fever for 1 week. Patient was a chronic smoker and used to smoke 10-20 beedis per day and he had no associated co-morbidities. On examination patient was tachypnoeic and had bilateral pitting pedal edema. Chest auscultation revealed bilateral extensive expiratory rhonchi with diminished breath sound in left hemithorax. Chest X-ray was taken which showed features of left hydro pneumothorax, following which ICD was inserted. CT thorax showed a large left hydro pneumothorax with BPF and bronchiectasis in left lower lobe with right lower lobe fibrosis. Bronchoscopy showed fistulous communication in superior segment of left lower lobe through which air and pleural fluid was draining. BPF closure was done by endobronchial injection of N-butyl cyanoacrylate glue into the superior segment of left lower lobe through the bronchoscopy following which wide swing in air column movement reduced with no air leaks. Keywords: Bronchopleural fistula; Bronchus; Pleural Space