Bronchomediastinal Fistula with Spontaneous Resolution in a Patient with Lung Cancer

Background: Bronchomediastinal fistula is an anomalous communication between the bronchial tree and mediastinum. It is a rare condition that occurs in the course of severe respiratory diseases such as rupture of bronchogenic cyst, descending necrotizing mediastinitis, tuberculous lymphadenitis, post-transplant lung infections and as a complication of treatment with chemotherapy or radiotherapy in bronchogenic tumours. Methods: We report the case of a 54-year-old male diagnosed with lung cancer four years ago, initially treated with surgery (lower left lobectomy), radiotherapy and chemotherapy, presenting recurrence and tumour progression in the last year. He came to the emergency department due to progressive dyspnoea in recent months. Chest computed tomography angiography was performed in which, besides progression of his neoplastic disease, an adenopathic mass-conglomerate was observed at the right parahilar mediastinal and subcarinal level, along with a fistula which communicated the necrotic subcarinal lymphadenopathy with the bronchus intermedius. Results: Flexible fibrobronchoscopy was performed, which confirmed the neoplastic disease (distal tracheal infiltration and in both main bronchi), with the existence of the aforementioned fistula, in the posterior wall of the bronchus intermedius, after bronchus exit from the right upper lobe, of 1.5 millimetres. The patient was scheduled for sealing the fistula with Bioglue® (surgical adhesive), a procedure proposed for ten days later. However, on the day of the operation spontaneous closure of the fistula was observed. The patient was discharged after clinical stabilization, dying at his home two months later due to overall deterioration secondary to the evolution of the neoplastic disease. Conclusion: This clinical case highlights, besides the appearance of a bronchomediastinal fistula (a rare entity), the fact that it had spontaneous resolution. This could be related to local adenopathic conglomerate tumour growth, which triggered the closure of the fistulous tract by compression. We did not find similar cases of respiratory fistula resolution without the need for specific treatment in the literature. Keywords: Adenopathic conglomerate, bioglue, bronchomediastinal fistula, bronchial tree, lung cancer, mediastinum.