Bronchopleural Fistula Following COVID-19 and Necrotizing Pneumonia in Childhood: Treatment With Intrapleural Vacuum-Assisted Closure Therapy.

Abstract

Bronchopleural fistula is an abnormal communication between the bronchial tree and the pleural space. Necrotizing pneumonia is a catastrophic infection of the lungs characterised by necrosis of the interstitial tissue. Although rarely reported, it has been described as a complication of COVID-19. The usual treatment for bronchopleural fistula involves endoscopic or surgical procedures. We present the case of a 5-year-old girl admitted with necrotizing pneumonia and difficult-to-control bronchopleural fistula, with a report of flu-like illness and a positive PCR test for COVID-19 2 months earlier. Over 38 days, several procedures were performed, including left-side tube drainage, thoracotomy, segmental resection, open window thoracotomy, and finally vacuum-assisted closure (VAC) therapy. Twenty days after the start of VAC therapy, complete closure of the bronchopleural fistula was achieved. At 26 months of follow-up, the child remained asymptomatic, with radiological examinations showing pulmonary expansion and absence of intrapleural air.