Bronchopleural Fistula: Causes, Diagnoses and Management

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and pleural space. This clinical condition, which has high mortality and morbidity, is one of the major therapeutic challenges for clinicians even today. BPF may result from a lung neoplasm, necrotizing pneumonia, empyema, blunt and penetrating lung injuries, and a complication of surgical procedures. Lung resection is the most common cause of BPF, and this chapter will focus more on this topic. Frequency ranges from 4.5 to 20% after pneumonectomy and from 0.5 to 1% after lobectomy. Several risk factors have been defined in the development of postoperative BPF; preoperative radiotherapy, pulmonary infection, diabetes, right pneumonectomy, a long bronchial stump, residual cancer at the stump (R1 and R2 resection), and the need for postoperative ventilation (especially with high PEEP). BPFs are divided, based on the time elapsed since surgery, into early or late fistula. This grouping is important in management of patient treatment. In early BPF, surgical treatment is generally the preferred treatment modality, whereas in late BPF, conservative approach is preferred. The management of BPF is still one of the most complex challenges encountered by the thoracic surgeons; so prevention is the best way to manage postoperative BPF.