Role of Computed Tomography in Guiding the Management of Peripheral Bronchopleural Fistula

Abstract

The present study was designed to elucidate whether demonstration of a peripheral bronchopleural fistula on CT correlated with the need for surgical management. We retrospectively identified 33 patients, 24 males and nine females, mean age 38 years, with clinical diagnosis of peripheral bronchopleural fistula and whose chest CT scans and medical charts were reviewed. Each chart was reviewed to identify the cause of the peripheral bronchopleural fistula and its treatment. Treatment decisions were categorized as surgical or conservative. Each chest CT was evaluated for the cause of peripheral bronchopleural fistula as follows: bulla(e), lung abscess/necrotizing pneumonia, neoplasms, peripheral bronchiectasis, and trauma. The peripheral bronchopleural fistula was classified as visible on CT if a distinct channel between the lung or a peripheral bronchus and the pleura was seen on the lung windows. We found that CT was useful in guiding surgery by identifying and localizing the cause of the peripheral bronchopleural fistula in the 55% (18/33) of patients who required surgery. The peripheral bronchopleural fistula or its probable cause was identified in 91% (30/33) as follows: bulla(e) (n = 12), lung abscess/necrotizing pneumonia (n = 11), peripheral bronchiectasis (n = 5), malignancy (n = 1), and posttraumatic pneumatocele (n = 1). The peripheral bronchopleural fistula was right-sided in 24, left-sided in nine, and was visible on CT in 36% (12/33). Among the patients with bullae, 58% (7/12) required surgery; however, the peripheral bronchopleural fistula was visible on CT in only 8% (1/12). Among the 21 patients without bulla(e), the peripheral bronchopleural fistula was visible on CT in 52% (11/21). When the fistula was visible in this subgroup, 73% (8/11) required surgery compared with 30% (3/10) in whom the fistula was not visible (p = NS; Fisher exact). In conclusion, CT was useful in guiding surgery by identifying and localizing the peripheral bronchopleural fistula or its probable cause. Peripheral bronchopleural fistulas caused by bulla(e) were less likely to be visible on CT (p < 0.05). Excluding patients with bulla(e), our data suggest a trend toward the need for surgical management for patients in whom the peripheral bronchopleural fistula was visible on CT.

An unusual presentation of pulmonary embolism leading to infarction, cavitation, abscess formation and bronchopleural fistulation

“…Ricci et al reported that of the patients who had BPF visible on CT scan, 73% (8/11) required surgical intervention compared with 30% (3/10) when BPF was not visible. CT was found to be useful in guiding surgery overall as it helped to identify and localise BPFs 7. Tsubakimoto et al examined the clinical outcome of 11 patients who had BPF.…”

A New Method to Detect Air Leakage in a Patient With Pneumothorax Using Saline Solution and Multidetector-Row Spiral CT Scan

“…A similar examinations using a CT scanner except in a handful of experimental studies. [6][7][8][9][10][11] We refer to our new method as "saline-fi lled CT thoracography." Aside from contrast thoracography with fl uoroscopy 10,11 and experimental scintigraphic studies with special radioisotopes, 6,12-14 there exist few nonsurgical methods for detecting air leakage.…”

Management options for the complicated pleural space

“…Conservative measures have variable success, with reports of 4-45 % of patients requiring more aggressive surgical or endoscopic intervention [25,87]. CT scans can be useful to help locate the BPF site before intervention [87].…”

“…CT scans can be useful to help locate the BPF site before intervention [87]. Surgical closure of BPF is successful in 80-100 % of cases [29,82].…”