Learning objectives
- Describe bronchopleural fistula, its causes, symptoms, and diagnosis
- Manage patients with a bronchopleural fistula
Definition & mechanisms
- A bronchopleural fistula (BPF) is a pathologic connection between the bronchus and the pleural space
- Potentially serious complication following pneumonectomy or other pulmonary resection
- Can be classified as acute, subacute, and chronic
- Acute: Caused by surgical dehiscence, potentially life-threatening, requires prompt surgical intervention
- Subacute & chronic: Mainly associated with infection, subacute more severe
Causes
- Breakdown of suture/staple line following lung resection
- Rupture of a cavity (cyst, abscess, bulla, bleb)
- Erosion of the bronchial wall by infection (empyema, pneumonia, tuberculosis)
- Erosion of the bronchial wall by neoplasm
- Penetrating trauma
- Pulmonary infarction
- Persistent spontaneous pneumothorax
- Chemotherapy or radiotherapy
- Iatrogenic
Signs & symptoms
| Acute BPF | Dyspnea Hypotension Subcutaneous emphysema Cough with expectoration of purulent fluid Tracheal or mediastinal shift Persistent air leak Reduction or disappearance of pleural effusion on chest radiograph |
| Subacute BPF | Wasting Malaise Fever |
| Chronic BPF | Infectious processes Fibrosis of the pleural space |
Diagnosis
- Instillation of methylene blue into the pleural space
- Bronchography
- Bronchoscopy
- CT
- Capnography
Management
Suggested reading
- Salik I, Vashisht R, Abramowicz AE. Bronchopleural Fistula. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534765/
- Kiyota Y, Topulos GP, Hartigan PM. Bronchopleural fistula. In: Aglio LS, Lekowski RW, Urman RD, eds. Essential Clinical Anesthesia Review: Keywords, Questions and Answers for the Boards. Cambridge: Cambridge University Press; 2015:518-519.
- Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
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