Treatment of empyema and bronchopleural fistula by bovine pericardium and latissimus flap

Management of empyema with bronchopleural fistula remains a challenge. A 38-year-old man who had bullous emphysema was hospitalized on account of a right-sided necrotizing pneumonia complicated by empyema that mandated a tube drainage. Persistent air leak from the chest tube was noted, and chest computed tomography confirmed an empyema cavity with a suspicious bronchopleural fistula. This complex condition was successfully treated using fibrin glue with buttressed bovine pericardium to seal the fistula, followed by obliteration of the empyema cavity using a pedicled muscle flap of the latissimus dorsi. There was no recurrence of empyema at a follow-up 5 years after this procedure.