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Bronchopleural fistula: case report A 63-year-old man developed bronchopleural fistula following treatment with carboplatin and etoposide for adenocarcinoma in the right upper lobe. The man, who had a history of hypertension, vascular disease and smoking, diagnosed with lung adenocarcinoma in the right upper lobe in December 2017. He received 3 courses of carboplatin/etoposide and radiation therapy [dosages and routes not stated]. After completion of chemoradiotherapy, he developed grade 3 dysphagia and weight loss, which persisted despite adequate unspecified treatment. Thereafter, a gastroscopy showed a radiation esophagitis with stenosis. A nasogastric tube was placed for tube feeding. In April 2018, he presented with acute dyspnoea, sepsis, tachycardia, right sided thoracic pain with reduced right sided airflow, hypotension, decreased oxygen saturation, leukocytosis and elevated CRP. A chest X-ray revealed right sided pleural effusion and atelectasis. Chest CT scan revealed a mediastinal air configuration of 3.5cm in possible continuation with the right main stem bronchus. He was admitted to the ICU with sepsis and acute respiratory failure due to empyema and pneumonia. The man was treated with unspecified antibiotics, fluid resuscitation and noninvasive ventilation. Bronchoscopy showed a bronchopleural fistula of 2cm in the right intermediate bronchus [duration of treatments to reaction onset not stated]. Then, chest tube was placed for drainage of the right-sided empyema. Ten days later, a repeat CT scan revealed a decrease of empyema and consolidations. However, the mediastinal air configuration remained unchanged. It was decided to give him antibiotics for intrapulmonary consolidations, enteral feeding and to perform surgery with a pedicled latissimus dorsi flap for coverage of fistula. His condition improved prior to the surgery. He underwent surgery under unspecified general anaesthesia. The latissimus dorsi muscle flap was harvested. Then, a thoracotomy was performed. The pedicled latissimus dorsi flap was draped and fixated dorsally to the bronchus to cover the defect. Then, intrathoracic chest tube was placed. The wound was closed. Thereafter, he recovered well. Six days later, he was transferred to the surgical ward. After surgery, limited air leakage persisted for 8 days. On day 15, he was transferred to the rehabilitation center. Ten weeks after surgery, he was readmitted with pneumonia, anaemia and haemoptysis. Bronchoscopy revealed a large defect of the intermediate bronchus. Due to no surgical options, palliative care was started. He died of bronchopleural fistula 3.5 months after surgery van de Pas JM, et al. Bronchopleural Fistula After Concurrent Chemoradiotherapy. Advances in Radiation Oncology 5: 511-515, No. 3, May-Jun 2020. Available from: URL: 803499429 http://doi.org/10.1016/j.adro.2019.12.006

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