Bronchial Tear and Tuberculous Bronchopleural Fistula Presenting as Recurrent Tension Pneumothorax: A Case Report

<p>Introduction: Bronchopleural Fistula (BPF) is a rare but potentially fatal complication of pulmonary tuberculosis, whereas nontraumatic bronchial tears are even less frequently reported. In advanced cavitary disease, progressive destruction of the bronchial wall may create a communication with the pleural space, resulting in persistent air leakage, recurrent pneumothorax, and acute respiratory deterioration. This report adds to the limited literature by describing a nontraumatic bronchial tear associated with a tuberculous BPF that presented as recurrent tension pneumothorax. </p><p> Case Presentation: A 33-year-old man presented with a 3-day history of hemoptysis and fever following 3 months of productive cough and weight loss. Sputum testing confirmed pulmonary tuberculosis, and drug-susceptibility testing demonstrated isoniazid resistance. Chest radiography showed cavitary and consolidative disease, while respiratory cultures yielded multiple concomitant organisms. His condition deteriorated after massive hemoptysis, cardiac arrest, and severe hypercapnic respiratory failure, requiring resuscitation, mechanical ventilation, and intensive care. On hospital day 23, a left pneumothorax was treated with chest tube drainage. On hospital day 29, persistent bubbling indicated an ongoing air leak, and chest radiography showed a massive tension pneumothorax despite the chest tube remaining in place. Emergency thoracotomy confirmed a BPF with a large bronchial tear, which was repaired by direct suturing and pleural flap reinforcement. After 43 days of multidisciplinary care, he was discharged in stable condition.</p><p> Conclusion: In advanced cavitary pulmonary tuberculosis, persistent air leakage or recurrent pneumothorax despite chest tube drainage should prompt urgent evaluation for BPF and bronchial disruption. Close reassessment, serial imaging, multidisciplinary care, and timely thoracic surgical intervention may be lifesaving when respiratory deterioration persists.</p>