Bronchopleural fistula
Updates to Article Attributes
Body
was changed:
Bronchopleural fistula 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
- may rarely be caused by pleuroparenchymal fibroelastosis 8
- lung necrosis complicating infection
- 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:
- pneumothorax
- hydropneumothorax
- pneumomediastinum
- underlying lung pathology
- demonstration of an actual fistulous communication
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 sulfur colloid
- 99mTc-labeled diethylenetriamine penta-acetate, 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.
-<p><strong>Bronchopleural fistula </strong>refers to a communication between the <a title="Intrapleural space" href="/articles/intrapleural-space">pleural space</a> and the <a title="Tracheobronchial tree" href="/articles/tracheobronchial-tree">bronchial tree</a>. </p><h4>Pathology</h4><h5>Causes</h5><ul>- +<p><strong>Bronchopleural fistula </strong>refers to a communication between the <a href="/articles/intrapleural-space">pleural space</a> and the <a href="/articles/tracheobronchial-tree">bronchial tree</a>. </p><h4>Pathology</h4><h5>Causes</h5><ul>
-</ul><h5>Nuclear medicine</h5><p>Radioaerosol scanning (e.g. xenon ventilation nuclear scintigraphy) has been successfully used in the evaluation of bronchopleural fistulas<sup> 5-7</sup>.</p>- +</ul><h5>Nuclear medicine</h5><p>Radioaerosol scanning (e.g. xenon ventilation nuclear scintigraphy) has been successfully used in the evaluation of bronchopleural fistulas<sup> 5-7</sup>.</p><p>A variety of radioactive tracers may be used including</p><ul>
- +<li>technetium-99m (99mTc) albumin colloid fog inhalation</li>
- +<li>99mTc sulfur colloid</li>
- +<li>99mTc-labeled diethylenetriamine penta-acetate, krypton, and xenon</li>
- +<li>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.</li>
- +</ul>
References changed:
- 10. Gaur P, Dunne R, Colson Y, Gill R. Bronchopleural Fistula and the Role of Contemporary Imaging. J Thorac Cardiovasc Surg. 2014;148(1):341-7. <a href="https://doi.org/10.1016/j.jtcvs.2013.11.009">doi:10.1016/j.jtcvs.2013.11.009</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24355543">Pubmed</a>
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