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Bronchopleural fistula

Bronchopleural fistula (BPF) refers to a communication between the pleural space and the bronchial tree. 

Pathology

Causes
  • post-operative complication of pulmonary resection: considered by far the most common cause, with a reported incidence from 1.5 to 28% after pulmonary resection1
  • lung necrosis complicating infection
  • persistent spontaneous pneumothorax 
  • chemotherapy or radiotherapy (for lung cancer) 
  • tuberculosis 4

Radiographic features

Plain film - chest radiograph

On a chest radiograph, a bronchopleural fistula usually appears as an intrapleural
air-pleural fluid collection - i.e a hydropneumothorax. The fistula itself is almost never
visualised directly but is implied in the proper clinical scenario. The air-fluid level
typically extends to the chest wall and shows unequal linear dimensions on orthogonal views conforming to the pleural space.

CT

CT is considered the imaging technique of choice for visualising and characterizing
bronchopleural fistulas 2. CT may directly show a fistulous connection.

Perstiting large amount of air within an empyema is also a concerning feature for a bronchopleural fistula

Scintigraphy

Radioaerosol scanning (e.g. xenon ventilation nuclear scintigraphy) has been successfully used in the evaluation of bronchopleural fistulas 5-7.

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