What is Bronchopleural Fistula | Causes | Symptoms | Diagnosis | Treatment | Outlook

A bronchopleural fistula is a condition that involves an abnormal passageway or a connection between the pleural cavity and lung airways. It may lead to shortness of breath and coughing.

Bronchial tubes or bronchi are the large airways in the lungs. The lungs are surrounded by 2 layers of membrane. The space in between the layers is known as the pleural cavity. Normally there is no passageway between the bronchi and the pleural cavity.

In the bronchopleural fistula, a connection develops between the pleural space and the bronchial cavity.

According to research, the incidence of bronchopleural fistulas has decreased due to improvements in tuberculosis treatment and lung.⁽¹⁾

Surgery including lobectomy and pneumonectomy is done to treat lung cancer and is the common cause of bronchopleural fistula.⁽²⁾

A study done in 2016 found that 2.2% of people developed bronchopleural fistula after lung cancer surgery.⁽³⁾ The rate was found to be 1.4% in the group that had undergone lobectomy and 14.3% in the group with pneumonectomy.

Bronchopleural fistula can develop at any time after surgery.

Lung tissue can get damaged due to lung infection and lead to bronchopleural fistula. A case study done in 2022 involved a person who was treated for bronchopleural fistula after he had a COVID-19 infection.⁽⁴⁾

Tuberculosis is also a possible cause of bronchopleural fistula. It is more prevalent in countries with a low-income group.⁽⁵⁾

In some, a bronchopleural fistula may not show any symptoms. Some may come to known they have it after they see an air leak in the imaging test.⁽²⁾

Bronchopleural fistula is classified as acute, subacute, and chronic.

An acute bronchopleural fistula occurs post-lung surgery and can be life-threatening.

A chronic or subacute bronchopleural fistula develops after infection and develops slowly.

The common symptoms of bronchopleural fistula include:

• Coughing up of blood
• Shortness of breath
• Cough with or without thick, yellow, and brown fluid
• Low blood pressure

The diagnosis of bronchopleural fistula involves a physical exam and imaging test such as a CT scan.⁽²⁾

CT scans create the pictures of lungs and chest cavity and may detect an air leak.

Bronchoscopy is also ordered to make a diagnosis. It involves inserting a scope with a camera attached to the person’s airway or lung. This helps in determining the location and size of the fistula.

The treatment may depend on the person’s symptom severity, the size of the fistula, and overall health. The treatment options for bronchopleural fistula include:

• Chest Tube Placement: It involves inserting a tube into the person’s chest to drain air and fluid from the pleural space.⁽²⁾ This procedure may be required after surgery to treat the fistula.
• Antibiotics: If an infection develops due to bronchopleural fistula antibiotics may be recommended to treat it.
• Surgery: The type of surgery may depend on the location and size of the fistula. An open chest procedure or bronchoscopy may be performed to repair the fistula.

The outlook for a person may depend on how early the treatment starts and the size of the fistula. The mortality ranges from 18-67%.⁽²⁾

Death due to a bronchopleural fistula may be due to respiratory distress syndrome. The risk of death is more in people with larger air leaks and those who require mechanical ventilation.

Also, the procedure success rate varies.