Management of refractory postpneumonectomy empyema with bronchopleural fistula

A 39-year-old female has postoperative empyema with bronchial stump fistula (BSF) after pneumonectomy due to ineffective tuberculosis chemotherapy. Transpleural reamputation of the right main bronchial stump with simultaneous 8-rib thoracoplasty, 6 attempts at endobronchial valve implantation and thoracostomy have failed to cure BSF and empyema. Consequently, an alternative treatment-transsternal transpericardial wedge-shaped resection of the tracheal bifurcation was performed despite its difficulty and was successful. This clinical case demonstrates the complications of BSF with tuberculosis empyema treatment in spite of there existing many alternative therapies. The need for new more effective treatments is highlighted, as well as safe and less technically difficult interventions which could assist patients with BSF.