Bronchopleural Fistula Diagnosed via Bronchoscopy

56 y/o M with PMHx of Osteochondroma presented with 2 weeks dyspnea, generalized weakness and fever. Patient initially believed he had viral syndrome and did not seek medical attention. He had sore throat a week prior to onset of his symptoms. On presentation to the Emergency Department, he was in respiratory failure. He was transiently placed on NIPPV and admitted to ICU. He had CT chest which suggested a right-sided hydro pneumothorax. Patient’s condition deteriorated, so patient was intubated in ICU, Frank pus was noted in the ET tube, so urgent bed side bronchoscopy was performed which drained 1000 cc of pus from right upper, and right middle lobe. Post procedure chest X-ray showed decrease in the fluid level, but persistent pneumo thorax suspecting a presence of a bronchopleural fistula Open tube thoracostomy drained another 2-3 L of pus in next 24 h. There was a persistent air leak, confirming diagnosis of bronchopleural fistula. Patient was treated with vancomycin, cefepime and flagyl. All cultures remained negative. Patient was discharged with chest tube, and 6-8 weeks of antibiotics.