Chest ImagingBronchopleural fistula
abnormal communication between a bronchus and the
pleural space that may lead to large persistent air leaks and/or
pleural infections. It is most commonly due to a necrotizing pneumonia, but traumatic cases are also frequent (Table 1). Bronchopleural fistulas complicating infections are considered under
empyema.
Bronchopleural fistula, Table 1. Causes of bronchopleural fistulas.
| Infection | |
| Necrotizing pneumonia/empyema (anaerobic, pyogenic, tuberculous, fungal) |
| Trauma | |
| Lobectomy |
| Pneumonectomy |
| Lung biopsy |
| Chest tube |
| Thoracocentesis |
| Radiation therapy |
| Oleothorax |
| Neoplasms | |
Postsurgical fistulae are suspected clinically with the postoperative development of fever, haemoptysis, cough and a persistent large air leak from the pleural drains. Direct visualization of the sinus tract which can be helpful in planning therapy often remains difficult, particularly in cases of peripheral fistulas. Bronchography rarely detects small leaks but may demonstrate large fistulae. Contiguous high resolution CT scans, as provided by helical thin collimation CT, is the most accurate technique for identifying peripheral bronchopleural fistula.
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