# Difficult Closure of Open‐Window Thoracostomy After Drainage of an Infected Pulmonary Bulla

## TL;DR

A case study shows challenges in closing a surgical chest tube after treating a lung infection with drainage.

## Contribution

Highlights the importance of identifying and closing all bronchial openings to prevent recurrence after open-window thoracostomy.

## Key findings

- Percutaneous drainage followed by OWT controlled infection but failed to close the thoracostomy due to recurring bronchial fistulae.
- Repeated surgeries were unsuccessful in closing the OWT window due to new bronchial openings appearing.
- Meticulous identification and closure of bronchial communications is critical for successful healing after OWT.

## Abstract

Percutaneous drainage can be used to treat infected pulmonary bullae unresponsive to antibiotics; however, it carries a high risk of bronchopleural fistula and empyema. We report the case of an elderly man with an infected pulmonary bulla successfully treated with percutaneous drainage followed by open‐window thoracostomy (OWT) for persistent air leakage. Although the infection was controlled, closing the OWT was challenging due to recurrent bronchial fistulae despite repeated surgeries. This case highlights the need to carefully identify and close all bronchial openings in the cyst wall to achieve successful closure after OWT in patients with severely infected bullae.

This report describes an elderly man with an infected pulmonary bulla successfully treated with percutaneous drainage followed by open‐window thoracostomy (OWT) for persistent air leakage. Despite infection control, repeated failures of window closure occurred due to newly appearing bronchial fistulae. The case highlights the importance of meticulous identification and closure of all bronchial communications to achieve definitive healing after OWT performed for an infected pulmonary bulla.