Table of ContentsView AllTable of ContentsSymptomsCausesPrevalenceDiagnosisTreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Prevalence
Diagnosis
Treatment
Frequently Asked Questions
Abronchopleural fistula(BPF), also known as a bronchopleural air leak, is an abnormal passageway that develops between the large airways in the lungs (the bronchi) and the space between the membranes that line the lungs (thepleural cavity).
This article looks at the symptoms and causes of bronchopleural fistula, how common it is, and how it’s diagnosed and treated.
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Symptoms of Bronchopleural Fistula
When a bronchopleural fistula develops, air that you breathe into your lungs can travel through it and enter the pleural space.
When a BPF does cause symptoms, they’re similar to what’s expected following lung infections and surgery. They include:
A BPF doesn’t always cause symptoms, though. When it’s asymptomatic, the diagnosis is often made after an imaging study reveals a persistent air leak.
Causes of Bronchopleural Fistula
Lung Cancer Surgery
BPF is most likely after apneumonectomy(complete removal of a lung). In one study, 1.4% of lobectomies (partial removal) and 14.3% of pneumonectomy led to a BPF.
It is also more common in those who have right-sided lung surgery.
Other Causes
How Common Is Bronchopleural Fistula?
Studies vary when looking at how common bronchopleural fistulas are. But it appears to occur in between 1.5% and 28% of surgeries involving lung removal.
It’s also more likely to occur:
Most often, a bronchopulmonary fistula occurs one to two weeks after lung surgery. However, it may occur even a month afterward.
Diagnosis of Bronchopleural Fistula
Healthcare providers usually diagnose bronchopleural fistulae based on radiological findings. A CT scan is often the test of choice. It may show increased air or fluid (often pus) in the pleural space.
A bronchopleural fistula is often discovered when providers can’t remove achest tubeafter lung surgery due to a persistent air leak. There may be continuous bubbling, or an air leak may be present only when you breathe in or breathe out.
With a small air leak, bubbling may only be present during forced exhalation or a cough.
Treatment of Bronchopleural Fistula
Healing the underlying cause of a fistula may also heal the fistula.
If a fistula is related to a surgery, it may need surgical correction. Three major steps—each a separate surgical procedure—are involved in treating a bronchopleural fistula.
Bronchopleural Fistula Repair
Fistula repair may be done: surgically or endoscopically
Recent studies suggest endoscopic procedures may be both safer and more effective for most people. If your condition isn’t stable, the endoscopic method may be the only suitable approach.
Summary
A BPF is life threatening but has a survival rate of at least 73%. Symptoms are a persistent cough, possibly with blood, pus, or a pink frothy fluid. It doesn’t always cause symptoms.
BPFs are diagnosed with a CT scan. They’re treated with fluid drainage, repair of the fistula, and sealing the pleural membranes together to prevent fluid accumulation.
A Word From Verywell
If you suspect a BPF, call 911 or get to an emergency room right away. If you’ve had surgery or are otherwise at risk for one, make sure the people taking care of you at home know the signs to watch for.
Yes, it can. It’s rare, though, and is usually associated with prior chemotherapy and radiation. The type of cancer most likely to lead to a BPF is Hodgkin’s lymphoma.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Zhang C, Pan Y, Zhang RM, Wu WB, Liu D, Zhang M.Late-onset bronchopleural fistula after lobectomy and adjuvant chemotherapy for lung cancer: A case report and review of the literature.Medicine (Baltimore). 2019;98(26):e16228. doi:10.1097/MD.0000000000016228
Fuso L, Varone F, Nachira D, et al.Incidence and management of post-lobectomy and pneumonectomy bronchopleural fistula.Lung. 2016;194(2):299-305. doi:10.1007/s00408-016-9841-z
Tsubakimoto M, Murayama S, Iraha R, Kamiya H, Tsuchiya N, Yamashiro T.Can peripheral bronchopleural fistula demonstrated on computed tomography be treated conservatively? A retrospective analysis.J Comput Assist Tomogr. 2016;40(1):86-90. doi:10.1097/RCT.0000000000000328
Ota T, Suzumura T, Sugiura T, et al.Spontaneous pneumothorax due to bronchopleural fistula following reirradiation for locoregionally recurrent squamous cell lung cancer.Clin Case Rep. 2016;4(5):481-485. Published 2016 Apr 1. doi:10.1002/ccr3.547
Teh E, West D.Bronchopleural fistula: prevention is still best.Shanghai Chest. 2017;1(6). doi:10.1186/s13019-022-02032-0
Birdas TJ, Morad MH, Okereke IC, et al.Risk factors for bronchopleural fistula after right pneumonectomy: does eliminating the stump diverticulum provide protection?.Ann Surg Oncol. 2012;19(4):1336-1342. doi:10.1245/s10434-011-2119-zBoudaya MS, Smadhi H, Zribi H, et al.Conservative management of postoperative bronchopleural fistulas.J Thorac Cardiovasc Surg. 2013;146(3):575-579. doi:10.1016/j.jtcvs.2013.04.023Bribriesco A, Patterson GA.Management of postpneumonectomy bronchopleural fistula: From thoracoplasty to transsternal closure.Thorac Surg Clin. 2018;28(3):323-335. doi:10.1016/j.thorsurg.2018.05.008
Birdas TJ, Morad MH, Okereke IC, et al.Risk factors for bronchopleural fistula after right pneumonectomy: does eliminating the stump diverticulum provide protection?.Ann Surg Oncol. 2012;19(4):1336-1342. doi:10.1245/s10434-011-2119-z
Boudaya MS, Smadhi H, Zribi H, et al.Conservative management of postoperative bronchopleural fistulas.J Thorac Cardiovasc Surg. 2013;146(3):575-579. doi:10.1016/j.jtcvs.2013.04.023
Bribriesco A, Patterson GA.Management of postpneumonectomy bronchopleural fistula: From thoracoplasty to transsternal closure.Thorac Surg Clin. 2018;28(3):323-335. doi:10.1016/j.thorsurg.2018.05.008
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