bronchopleural fistula

{{Short description|Abnormal lung–pleural space connection}}

A bronchopleural fistula (BPF) is a fistula between the pleural space and the lung. It can develop following pneumonectomy, lung ablation, post-traumatically, or with certain types of infection.{{Cite journal|last1=Shahrouki|first1=Puja|last2=Barclay|first2=Jonathan|last3=Khan|first3=Sarah|last4=Genshaft|first4=Scott|last5=Abtin|first5=Fereidoun|last6=McGraw|first6=Charles|last7=Baek|first7=Donny|last8=Nickel|first8=Barbara|last9=Suh|first9=Robert|date=February 2021|title=Treatment of Post-Ablation Bronchopleural Fistula Using Percutaneous Synthetic Hydrogel Surgical Sealant: Initial Experience of Safety and Efficacy|url=https://pubmed.ncbi.nlm.nih.gov/33174141|journal=CardioVascular and Interventional Radiology|volume=44|issue=2|pages=325–332|doi=10.1007/s00270-020-02691-3|issn=1432-086X|pmid=33174141|s2cid=226294934 }}Varoli F (1998) Endoscopic treatment of bronchopleural fistulas. Annals of Thoracic Surgery 65, 807-9 It may also develop when large airways are in communication with the pleural space following a large pneumothorax or other loss of pleural negative pressure, especially during positive pressure mechanical ventilation.{{cite journal|last1=Kempainen|first1=RR|last2=Pierson|first2=DJ|title=Persistent air leaks in patients receiving mechanical ventilation.|journal=Seminars in Respiratory and Critical Care Medicine|date=December 2001|volume=22|issue=6|pages=675–84|pmid=16088712|doi=10.1055/s-2001-18804|s2cid=36172602 }} On imaging, the diagnosis is suspected indirectly on radiograph. Increased gas in the pneumonectomy operative bed, or new gas within a loculated effusion are highly suggestive of the diagnosis. Infectious causes include tuberculosis, Actinomyces israelii, Nocardia, and Blastomyces dermatitidis. Malignancy and trauma can also result in the abnormal communication.{{cite journal|last1=Lois|first1=M|last2=Noppen|first2=M|title=Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management.|journal=Chest|date=December 2005|volume=128|issue=6|pages=3955–65|pmid=16354867|doi=10.1378/chest.128.6.3955}}