Diagnosis and Management Bronchopleural Fistula

Abstract

The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and mortality. Diagnosis and localisation of BPF is sometimes difficult and may require multiple imaging and bronchoscopies. Successful management of a fistula is combined with treatment of the associated empyema cavity. The first step, therefore, should be control of active infection and adequate drainage of the hemithorax. When deemed required, definitive surgical repair should be accomplished expeditiously, minimising the number of procedures performed. In cases of a small fistula or where the surgical risk is high, various bronchoscopic methods have been used to close the fistula. When treatment is protracted, secondary complications are more likely and survival is adversely affected. In this article, approaches to the diagnosis and treatment of BPF are discussed, with particular emphasis on bronchoscopic management options.

Acquired Thoracic Fistulas

“…Examples of noninfectious causes include cyst rupture, traumatic lacerations, vasculitis, rheumatoid arthritis, and chemotherapy or radiotherapy. 1,5,6 BPFs may be occult on bronchoscopy, particularly those that are peripheral, making imaging a critical component to proper diagnosis. 6 Chest radiography may demonstrate a new or larger pneumothorax, with multidetector computed tomography (CT) offering greater sensitivity.…”

“…1,5,6 BPFs may be occult on bronchoscopy, particularly those that are peripheral, making imaging a critical component to proper diagnosis. 6 Chest radiography may demonstrate a new or larger pneumothorax, with multidetector computed tomography (CT) offering greater sensitivity. 4 In the presence of a pleural effusion, this translates to a new gaseous component or the lowering of a gas-liquid level.…”

“…3). Examples of noninfectious causes include cyst rupture, traumatic lacerations, vasculitis, rheumatoid arthritis, and chemotherapy or radiotherapy 1,5,6…”

Prevalence and treatment outcome of bronchopleural fistula: a multi-center study in Ethiopia

“…Bronchopleural fistula (BPF) is a sinus tract between the bronchus and the pleural space that may result from necrotizing pneumonia, lung neoplasm, blunt and penetrating lung injuries, may occur as a complication of procedures or may complicate radiation therapy [ 1 , 2 ]. It is one of the serious complications of pulmonary tuberculosis which is almost always associated with pleural space infection [ 2 ].…”

Persistent Air Leak

“…This condition facilitates the retention of secretions in the right main bronchus.CLINICAL PRESENTATIONThe acute stage, clinical presentation of PAL can be a life-threatening condition due to a tension pneumothorax or shortness of breath due to lung compression. Sudden onset of dyspnea, hypotension, subcutaneous emphysema, cough with purulent sputum expectoration, tracheal and mediastinal displacement, ongoing air leaks, and diminished or absent pleural effusion on chest radiographs are symptoms for the postoperative cases of PAL 13.…”