Bronchoscopic management of bronchopleural fistula

Abstract

Bronchopleural fistula (BPF) represents a pathological communication between any part of bronchial tree and the pleural space. Mostly it is a rare yet serious complication of different pulmonary conditions like certain infections, trauma, malignancy and/or surgery, going along with significant mortality reported to be as high as 58%. Diagnosis of BPF is mostly done by evaluating these three data: clinical appearance, bronchoscopy and CT scan. The treatment of BPF may initially differ according to the time of appearance as well as clinical presentation. As most BPF goes along with empyema, it is, obviously, necessary to deal with it. This is most commonly achieved with a chest tube. Conservative management of BPF can be achieved using a significant variety of materials and methods with reportedly moderate to excellent results in the treatment of etiologically and sizably different BPF. Methyl-2-cyanoacrylate, fibrin sealant together with spongy calf bone, polidocanol -hydroxypolyethoxidodecane, amplatzer device, silver nitrate, stenting and endobronchial valves have all been employed in bronchoscopic treatment of a BPF. There is no evidence based guideline for its management, either surgically or endoscopically. The treatment of choice is always in the hands of the physician, preferably armed with the current knowledge and capacity of utilizing it.