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VOLUME 52 , ISSUE 2 ( April-June, 2010 ) > List of Articles


Diagnosis and Management Bronchopleural Fistula

Pralay Sarkar, Twinkle Chandak, Rakesh Shah, Arunabh Talwar

Keywords : Bronchopleural fistula, Fiberoptic bronchoscopy, Surgery, Diagnosis

Citation Information : Sarkar P, Chandak T, Shah R, Talwar A. Diagnosis and Management Bronchopleural Fistula. Indian J Chest Dis Allied Sci 2010; 52 (2):97-104.

DOI: 10.5005/ijcdas-52-2-97

License: CC BY-NC 4.0

Published Online: 10-06-2022

Copyright Statement:  Copyright © 2010; The Author(s).


The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and mortality. Diagnosis and localisation of BPF is sometimes difficult and may require multiple imaging and bronchoscopies. Successful management of a fistula is combined with treatment of the associated empyema cavity. The first step, therefore, should be control of active infection and adequate drainage of the hemithorax. When deemed required, definitive surgical repair should be accomplished expeditiously, minimising the number of procedures performed. In cases of a small fistula or where the surgical risk is high, various bronchoscopic methods have been used to close the fistula. When treatment is protracted, secondary complications are more likely and survival is adversely affected. In this article, approaches to the diagnosis and treatment of BPF are discussed, with particular emphasis on bronchoscopic management options.

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  1. McManigle JE, Fletcher GL, Tenholder MF. Bronchoscopy in the management of bronchopleural fistula. Chest 1990;97:1235-8.
  2. Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. Bronchopleural fistulas associated with lung cancer operations: univariate and multivariate analysis of risk factors, management, and outcome. J Thorac Cardiovasc Surg 1992;104:1456-64.
  3. Darling GE, Abdurahman A, Yi QL, Johnston M, Waddell TK, Pierre A, et al. Risk of a right pneumonectomy: role of bronchopleural fistula. Ann Thorac Surg 2005;79:433-7.
  4. Javadpour H, Sidhu P, Luke DA. Bronchopleural fistula after pneumonectomy. Ir J Med Sci 2003;172:13-15
  5. Hollaus PH, Lax F, el-Nashef BB, Hauck HH, Lucciarini P, Pridun NS. Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg 1997;63:1391-6; discussion 1396-7.
  6. Baumann MH, Sahn SA. Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest 1990;97:721-8.
  7. Varoli F, Roviaro G, Grignani F, Vergani C, Maciocco M, Rebuffat C. Endoscopic treatment of bronchopleural fistulas. Ann Thorac Surg 1998;65:807-9.
  8. Hollaus PH, Lax F, Janakiev D, Lucciarini P, Katz E, Kreuzer A, et al. Endoscopic treatment of postoperative bronchopleural fistula: experience with 45 cases. Ann Thorac Surg 1998;66:923-7.
  9. Kirsh MM, Rotman H, Behrendt DM, Orringer MB, Sloan H. Complications of pulmonary resection. Ann Thorac Surg 1975;20:215-36.
  10. Kim EA, Lee KS, Shim YM, Kim J, Kim K, Kim TS, et al. Radiographic and CT findings in complications following pulmonary resection. Radiographics 2002;22:67-86.
  11. Lauckner ME, Beggs I, Armstrong RF. The radiological characteristics of bronchopleural fistula following pneumonectomy. Anaesthesia 1983;38:452-6.
  12. Peters ME, Gould HR, McCarthy TM. Identification of a bronchopleural fistula by computerized tomography: a case report. J Comput Tomogr 1983;7:267-70.
  13. Westcott JL, Volpe JP. Peripheral bronchopleural fistula: CT evaluation in 20 patients with pneumonia, empyema, or postoperative air leak. Radiology 1995;196:175-81.
  14. Vogel N, Wolcke B, Kauczor HU, Kelbel C, Mildenberger P. [Detection of a bronchopleural fistula with spiral CT and 3D reconstruction]. Aktuelle Radiol 1995;5:176-8.
  15. York EL, Lewall DB, Hirji M, Gelfand ET, Modry DL. Endoscopic diagnosis and treatment of postoperative bronchopleural fistula. Chest 1990;97:1390-92.
  16. Matthew TL, Spotnitz WD, Kron IL, Daniel TM, Tribble CG, Nolan SP. Four years’ experience with fibrin sealant in thoracic and cardiovascular surgery. Ann Thorac Surg 1990;50:40-43; discussion 43-44.
  17. Pigula FA, Keenan RJ, Naunheim KS, Ferson PF, Landreneau RJ. Diagnosis of postpneumonectomy bronchopleural fistula using ventilation scintigraphy. Ann Thorac Surg 1995;60:1812-4.
  18. Carp L, De Bondt P, Van Schil P, Blockx P. Ventilation scintigraphy for the detection of bronchopleural fistulae. Eur J Nucl Med 1999;26:1379-80.
  19. Greyson ND, Rosenthall L. Detection of postoperative bronchopleural fistulas by radionuclide fog inhalation. Candian Med Assoc J 1970;103:1366-8.
  20. Hollett P, Wright E, Wesolowski C, Harris R. Aerosol ventilation scintigraphy in the evaluation of bronchopleural fistula: a case report and literature review. Candian J Surg 1991;34:465-7.
  21. Vincken W, Schandevyl W, Sonstabo R, Bossuyt A. Demonstration of a bronchopleural communication by inhalation of Kr-81m gas. Clin Nucl Med 1981;6:117-9.
  22. Lowe RE, Siddiqui AR. Scintimaging of bronchopleural fistula: a simple method of diagnosis. Clin Nucl Med 1984; 9:10-12.
  23. Raja S, Rice TW, Neumann DR, Saha GB, Khandekar S, MacIntyre WJ, et al. Scintigraphic detection of postpneumonectomy bronchopleural fistulae. Eur J Nucl Med 1999;26:215-9.
  24. Nielsen KR, Blake LM, Mark JB, DeCampli W, McDougall IR. Localization of bronchopleural fistula using ventilation scintigraphy. J Nucl Med 1994;35:867-9.
  25. Ali SA, Hogge M, Cesani F. Localization of a bronchopleural fistula in a postpneumonectomy patient using ventilation scintigraphy. Clin Nucl Med 1995;20:943.
  26. Lillington GA, Stevens RP, DeNardo GL. Bronchoscopic location of bronchopleural fistula with xenon-133. J Nucl Med 1982;23:322-3.
  27. Sarkar P, Patel N, Chusid J, Shah R, Talwar A. The role of computed tomography bronchography in the management of bronchopleural fistulas. J Thorac Imaging 2010; 25:W10-3.
  28. McLaren CA, Elliott MJ, Roebuck DJ. Tracheobronchial intervention in children. Eur J Radiol 2005;53:22-34.
  29. Baldwin JC, Mark JB. Treatment of bronchopleural fistula after pneumonectomy. J Thorac Cardiovasc Surg 1985; 90:813-7.
  30. McGuive GP. Lung ventilation and bronchopleural fistula. Canadian J Anaesth 1996;43:1275-6.
  31. Pierson DJ, Horton CA, Bates PW. Persistent bronchopleural air leak during mechanical ventilation: a review of 39 cases. Chest 1986;90:321-3.
  32. Miren A Schinco VAF, Thomas A Santora. Ventilatory management of a bronchopleural fistula following thoracic surgery. Respir Care 1998;43:1064-9.
  33. Rusch VW, Capps JS, Tyler ML, Pierson DL. The performance of four pleural drainage systems in an animal model of bronchopleural fistula. Chest 1988;93:859-63.
  34. Tilles RB, Don HF. Complications of high pleural suction in bronchopleural fistulas. Anesthesiology 1975;43:486-7.
  35. Sager JS, Eiger G, Fuchs BD. Ventilator auto-triggering in a patient with tuberculous bronchopleural fistula. Respir Care 2003;48:519-21.
  36. Zimmerman JE, Colgan DL, Mills M. Management of bronchopleural fistula complicating therapy with positive end expiratory pressure (PEEP). Chest 1973;64:526-9.
  37. Bar-El Y, Ross A, Kablawi A, Egenburg S. Potentially dangerous negative intrapleural pressures generated by ordinary pleural drainage systems. Chest 2001;119:511-4.
  38. Miller KS, Sahn SA. Chest tubes: Indications, technique, management and complications. Chest 1987;91:258-64.
  39. Walsh MC, Carlo WA. Determinants of gas flow through a bronchopleural fistula. J Appl Physiol 1989;67:1591-6.
  40. Ha DV, Johnson D. High frequency oscillatory ventilation in the management of a high output bronchopleural fistula: a case report. Can J Anaesth 2004;51:78-83.
  41. Feeley TW, Keating D, Nishimura T. Independent lung ventilation using high-frequency ventilation in the management of a bronchopleural fistula. Anesthesiology 1988;69:420-22.
  42. Carvalho P, Thompson WH, Riggs R, Carvalho C, Charan NB. Management of bronchopleural fistula with a variable-resistance valve and a single ventilator. Chest 1997;111:1452-4.
  43. Pairolero PC, Arnold PG, Trastek VF, Meland NB, Kay PP. Postpneumonectomy empyema: The role of intrathoracic muscle transposition. J Thorac Cardiovasc Surg 1990; 99:958-66; discussion 966-8.
  44. Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest 2005;128:3955-65.
  45. Lan RS, Lee CH, Tsai YH, Wang WJ, Chang CH. Fiberoptic bronchial blockade in a small bronchopleural fistula. Chest 1987;92:944-46.
  46. Martin WR, Siefkin AD, Allen R. Closure of a bronchopleural fistula with bronchoscopic instillation of tetracycline. Chest 1991;99:1040-42.
  47. Sprung J, Krasna MJ, Yun A, Thomas P, Bourke DL. Treatment of a bronchopleural fistula with a Fogarty catheter and oxidized regenerated cellulose (surgicel). Chest 1994;105:1879-81.
  48. Potaris K, Mihos P, Gakidis I. Experience with an albuminglutaraldehyde tissue adhesive in sealing air leaks after bullectomy. Heart Surg Forum 2003;6:429-33.
  49. Finch CK, Pittman AL. Use of fibrin glue to treat a persistent pneumothorax with bronchopleural fistula. Am J Health Syst Pharm 2008;65:322-4.
  50. Goussard P, Gie RP, Kling S, Kritzinger FE, van Wyk J, Janson J, et al. Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post-tuberculosis bronchiectasis. Pediatr Pulmonol 2008; 43:721-5.
  51. Scappaticci E, Ardissone F, Ruffini E, Baldi S, Mancuso M. Postoperative bronchopleural fistula: endoscopic closure in 12 patients. Ann Thorac Surg 1994;57:119-22.
  52. Arunabh IJ, Hartman A, Fein AM. Bronchopleural fistula. Bronchology 1998;5:225-6.
  53. Glover W, Chavis TV, Daniel TM, Kron IL, Spotnitz WD. Fibrin glue application through the flexible fiberoptic bronchoscope: closure of bronchopleural fistulas. J Thorac Cardiovasc Surg 1987;93:470-2.
  54. Torre M, Quaini E, Ravini M, Nerli FP, Maioli M. 1987: Endoscopic gluing of bronchopleural fistula. Updated in 1994. Ann Thorac Surg 1994;58:901-2.
  55. Eng J, Sabanathan S. Tissue adhesive in bronchial closure. Ann Thorac Surg 1989;48:683-85.
  56. Tsunezuka Y, Sato H, Tsukioka T, Hiranuma C. A new instrument for endoscopic gluing for bronchopleural fistulae. Ann Thorac Surg 1999;68:1088-9.
  57. Brennan M. Fibrin glue. Blood Rev 1991;5:240-4.
  58. Ellis JH, Sequeira FW, Weber TR, Eigen H, Fitzgerald JF. Balloon catheter occlusion of bronchopleural fistulae. AJR Am J Roentgenol 1982;138:157-9.
  59. Houpt P, Van Zanten JJ, Bins MC. The use of balloon catheters in the treatment of high-flow bronchopleural fistulae complicating mechanical ventilation. Neth J Med 1983;26:34-8.
  60. Otruba Z, Oxorn D. Lobar bronchial blockade in bronchopleural fistula. Can J Anaesth 1992; 39:176-78.
  61. Zhang J, Hu S, Gao B, Liu D, Song F, Li B, et al. Interventional closure of postpneumonectomy bronchial pleural fistula with a self-expandable double umbrellashaped occluder knitted with nitinol shape memory alloy. J Thorac Cardiovasc Surg 2007;134:531-33.
  62. D.E. Wood XG, Sirokman W, Dillard D, Springmeyer SC. Reduction of severe air leaks using an Intra-bronchial valve delivered via flexible bronchoscopy. Am Respri Crit Care Med 2004;169:A480.
  63. Toma TP, Kon OM, Oldfield W, Sanefuji R. Griffiths M, Wells F, et al. Reduction of persistent air leak with endoscopic valve implants. Thorax 2007;62:830-33.
  64. Feller-Kopman D, Bechara R, Garland R, Ernst A, Ashiku S. Use of a removable endobronchial valve for the treatment of bronchopleural fistula. Chest 2006;130:273-5.
  65. Uchida T, Wada M, Sakamoto J, Arai Y. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case. Surg Today 1999;29:186-9.
  66. Sivrikoz CM, Kaya T, Tulay CM, Ak I, Bilir A, Döner E. Effective approach for the treatment of bronchopleural fistula: application of endovascular metallic ring-shaped coil in combination with fibrin glue. Ann Thorac Surg 2007; 83:2199-01.
  67. Hirata T, Ogawa E, Takenaka K, Uwokawa R, Fujisawa I. Endobronchial closure of postoperative bronchopleural fistula using vascular occluding coils and n-butyl-2- cyanoacrylate. Ann Thorac Surg 2002;74:2174-6.
  68. Watanabe S, Shimokawa S, Yotsumoto G, Sakasegawa K. The use of a Dumon stent for the treatment of a bronchopleural fistula. Ann Thorac Surg 2001;72:276-8.
  69. Tayama K, Eriguchi N, Futamata Y, Harada H, Yoshida A, Matsunaga A, et al. Modified Dumon stent for the treatment of a bronchopleural fistula after pneumonectomy. Ann Thorac Surg 2003;75:290-92.
  70. Tulloch-Reid M, Pyne D, Baker T, Ebanks F, Sterman D. Tracheobronchial stenting for management of bronchopleural fistula: a novel solution to an old problem. West Indian Med J 2006;55:288-90.
  71. Takaoka K, Inoue S, Ohira S. Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 2002;122:374-8.
  72. Kanno R, Suzuki H, Fujiu K, Ohishi A, Gotoh M. Endoscopic closure of bronchopleural fistula after pneumonectomy by submucosal injection of polidocanol. Jpn J Thorac Cardiovasc Surg 2002;50:30-33.
  73. Wang KP, Schaeffer L, Heitmiller R, Baker R. NdYAG laser closure of a bronchopleural fistula. Monaldi Arch Chest Dis 1993;48:301-3.
  74. Roksvaag H, Skalleberg L, Nordberg C, Solheim K, Hoivik B. Endoscopic closure of bronchial fistula. Thorax 1983; 38:696-7.
  75. Mora G, de Pablo A, Garcia-Gallo CL, Laporta R, Ussetti P, Gámez P, et al. [Is endoscopic treatment of bronchopleural fistula useful?]. Arch Bronconeumol 2006;42:394-8.
  76. West D, Togo A, Kirk AJ. Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula an effective alternative to repeat thoracotomy? Interact Cardiovasc Thorac Surg 2007;6:547-50.
  77. Singh N, Agarwal R. Bronchopleural fistula or alveolopleural fistula? Not just semantics. Chest 2006;130:1948; author reply 1948-9.
  78. Bayfield MS, Spotnitz WD. Fibrin sealant in thoracic surgery. Pulmonary applications, including management of bronchopleural fistula. Chest Surg Clin N Am 1996; 6:567-83.
  79. Mukaida T, Andou A, Date H, Aoe M, Shimizu N. Thoracoscopic operation for secondary pneumothorax under local and epidural anesthesia in high-risk patients. Ann Thorac Surg 1998;65:924-6.
  80. Samuels LE, Shaw PM, Blaum LC. Percutaneous technique for management of persistent airspace with prolonged air leak using fibrin glue. Chest 1996;109:1653-5.
  81. Heffner JE, Standerfer RJ, Torstveit J, Unruh L. Clinical efficacy of doxycycline for pleurodesis. Chest 1994; 105:1743-47.
  82. Travaline JM, Criner GJ. Persistent bronchopleural fistulae in an AIDS patient with Pneumocystis carinii pneumonia: successful treatment with chemical pleurodesis. Chest 1993;103:981.
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