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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 chest radiography the features that may be seen include

  • steady increase in intrapleural air space
  • appearance of new intrapleural air-pleural fluid collection - i.e a hydropneumothorax. The air-fluid level typically extends to the chest wall and shows unequal linear dimensions on orthogonal views conforming to the pleural space.
  • changes in an already present air fluid level
  • development of tension pneumothorax
  • a drop in the air fluid level exceeding 2cm (if patient has no chest tube in place)
CT

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

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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