BRONCHOPLEURAL FISTULA POST LOBECTOMY: A RARE COMPLICATION WITH AN EVEN MORE UNUSUAL PRESENTATION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: The formation of a bronchopleural fistula (BPF) is rare but known complication following major thoracic surgery. In study by Nachira et al. looking at 835 patients in Italy who underwent lung resection, 786 lobectomy with 11 (1.3%) developing BPF [1]. other studies their incidence has been reported between 0.5-3% [2]. Here we present case an unusual presentation this complication. CASE PRESENTATION: 73 y.o F former smoker was incidentally found to have right upper lobe (RUL) chondral myxoid tumor. She bronchoscopy and video assisted thoracoscopy (VATS) wedge resection RUL placement chest tube without peri-operative complications. Later that day, rapid response called as patient developed facial swelling, sensation throat tightening erythema subcutaneous emphysema (SCE) (Figure 1). Initial thought possible anaphylaxis from NSAIDs treated such. Patient later further deteriorated leading intubation transfer the ICU. Second right-sided skin holes placed on for relief air. extubated next day. Due persistent SCE 2) need respiratory support, received bilateral blow-holes downgraded surgical floor after improvement. Symptoms again recurred requiring re-intubation. Blow-holes were extended 3rd placed. taken repeat VATS adhesions. Lysis adhesions performed mediastinal drainage mechanical pleural abrasion. rest patient's hospital course uncomplicated eventual removal tubes discharge. DISCUSSION: As discussed, our had complicated post-operative course, unique her BPF. We no previous literature or reports illustrating similar presenting symptoms BPFs. They typically 1 - 12 weeks postoperatively Our did not fit timeline very atypical which mimicked anaphylactoid reaction. Although diffuse finding BPFs [3], be normal result recent procedure. This uncommon led delay appropriate management patient. CONCLUSIONS: demonstrates potentially fatal surgeries. may considered similarly future. REFERENCE #1: D, Chiappetta M, Fuso L, Varone F, Leli I, Congedo MT, Margaritora S, Granone P. Analysis risk factors development anatomic resection: experience single centre. ANZ J Surg.2018 Apr;88(4):322-326.doi: 10.1111/ans.13886. Epub 2017 Feb 1.PMID: 28147437. #2: Gaur P, Dunne R, Colson YL, Gill RR. Bronchopleural role contemporary imaging. Thorac Cardiovasc Surg. 2014 Jul;148(1):341-7. doi: 10.1016/j.jtcvs.2013.11.009. 2013 Dec 16. PMID: 24355543. #3: Anas Riehani, Olivia Wilcox, Wassim Mohammed Odeh, Michael Kehdi, John Armstrong. Fistula Presenting Subcutaneous Emphysema. C46. PLEURAL DISEASE: REPORTS II. May 1, 2017, A5647-A5647 DISCLOSURES: No relevant relationships Inessa Bronshteyn, source=Web Response Kyle Foster, Janeen Grant-Sittol, Ross Lavine, Anna-Belle Robertson,