Bronchopleural fistula

Bronchopleural fistulas are communications between the bronchial tree and the pleural space

Pathology

They are usually divided as:

  • central: when the fistula involves the trachea or a lobar bronchus
  • peripheral: when a distal airway, either segmental bronchi or the lung parenchyma, communicates to the pleural space
Aetiology
  • 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 or infarction
  • persistent spontaneous pneumothorax 
  • chemotherapy or radiotherapy (for lung cancer
  • tuberculosis 4

Radiographic features

Plain radiograph

On chest radiography, the features that may be seen include:

  • steady increase in intrapleural airspace
  • appearance of a 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 the patient has no chest tube in place)
CT

CT is considered the imaging technique of choice for visualising and characterising bronchopleural fistulae 2. CT may show:

Nuclear medicine

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

A variety of radioactive tracers may be used including:

  • technetium-99m (99mTc) albumin colloid fog inhalation
  • 99mTc sulphur colloid
  • 99mTc-labelled diethylenetriamine pentaacetate, krypton, and xenon
  • single photon emission tomography using radiolabeled aerosol inhalation. If there is fistula the radioactive tracer will equilibrate between the postpneumonectomy or pleural space and the airways after inhalation
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Article information

rID: 17012
System: Chest
Synonyms or Alternate Spellings:
  • Bronchopleural fistulation
  • Broncho-pleural fistula
  • Broncho-pleural fistulation
  • Bronchopleural fistula (BPF)
  • Broncho-pleural fistulas

Cases and figures

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    Case 1: plain film
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    Case 1: CT
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     Case 2: plain film
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    Case 3
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    Case 4
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    Case 5: following Clagett thoracotomy
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