Bronchopleural fistula complicating massive pulmonary infarction.

The clinical course of a patient who developed a lung abscess with a bronchopleural fistula following a massive infarction is described. Comparison of the events in this patient's illness with others reported in the literature reveals a recognizable syndrome which is characterized by three phases. The initial illness consists of massive infarction with its well-recognized sequelae. Following a short period of improvement, the second phase begins with the production of copious amounts of blood-tinged or purulent sputum, accompanied by fever, leucocytosis, and cardiac decompensation. This phase lasts several days to weeks and signifies excavation of the infarcted area. After another period of relative quiescence, the third phase, characterized by the abrupt onset of fever, pleuritic pain, cough, and acute dyspnoea, begins. These symptoms herald bronchopleural fistula. In view of the high mortality, prompt recognition of this syndrome and vigorous treatment appear to be mandatory.