Role of computed tomography virtual bronchoscopy in a case of pulmonary tuberculosis complicated by bronchopleural fistula and pyopneumothorax

Bronchopleural fistula (BPF) refers to an abnormal passage connecting the bronchial tree to the pleural cavity, which may arise from infection, trauma, or post-surgical complications. When associated with tuberculosis (TB), its insidious and slowly progressive nature often delays recognition, complicating timely management. This case highlights a rare presentation of large tuberculous peripheral bronchopleural fistula in a young adult, complicated by massive pyopneumothorax and ultimately requiring pneumonectomy, a rare intervention in this age group. The patient, on his fifth month of anti-tuberculosis therapy, showed symptoms of fever, productive cough, weight loss, and respiratory distress. Imaging revealed left-lung consolidation with "tree-in bud" nodule, and ground-glass opacity, together with extensive right-sided pyopneumothorax. Chest computed tomography and virtual bronchoscopy confirmed a 19-mm fistulous tract arising from the right secondary bronchus. In TB-related BPF, structural lung damage may occur through ruptured cavities or erosion of caseating lymph nodes, forming sinus tracts that permit persistent air and purulent drainage into the pleural space. When conventional bronchoscopy is limited computed tomography and virtual bronchoscopy provide reliable noninvasive visualization of the fistula and airways, enabling accurate diagnosis and management planning.