Bronchopleural Fistula:
Clinical:
Bronchopleural fistulas are a communication between an airway and the pleural space which can occur following pulmonary infection with a necrotizing pneumonia (most common), blunt or penetrating chest trauma (usually involve large airways), or following pulmonary resection (uncommon). Iatrogenic causes include complications of thoracentesis, pleural drains, and ventilator support with positive end-expiratory pressure. Etiologies or factors which increase the risk for post-surgical bronchopleural fistula include infection of the bronchial stump, residual tumor, extensive resection, adjuvant chemo/ XRT therapy, and underlying conditions such as diabetes. Treatment requires chest tube drainage, unless the condition is secondary to a malignancy.X-ray:
On the CXR a bronchopleural fistula usually appears as an intrapleural air-fluid level (hydropneumothorax). The air-fluid level typically extends to the chest wall and demonstrates unequal linear dimensions on orthogonal views, conforming to the pleural space (remember, an air-fluid level within an abscess usually has the same dimensions on orthogonal views). A differential consideration for the presence of a hydropneumothorax is pleural space infection with a gas-forming organism.REFERENCES:
(1) AJR 1996; Stern EJ, et al. Peripheral bronchopleural fistulas: CT imaging features. 167: 117-120 (No abstract available)
