Fig. 1

The computed tomography scan revealed a diagnosis of fistulous empyema, linked to the perforation of the right middle lobe abscess (arrow) (A). Following the thoracoscopic curettage of the right empyema cavity, we conducted a right middle lobectomy, and utilized intercostal muscle flap coverage over the bronchial stump was performed. Seven months after the surgical procedure, a bronchial fistula developed (B). After performing window open thoracotomy, our attempt at closing the bronchial fistula using multiple endobronchial Watanabe spigot (EWS) proved unsuccessful (C)