Bronchopleural Fistula – CT

History: 65 year old male with a chronic right sided hydropneumothorax for 3 years after spontaneous pneumothorax. 

Bronchopleural fistula:  Single axial CT scan in lung windows shows a large right sided hydropneumothorax with apparent communication with a bronchus in an area of scarring and traction bronchiectasis, worrisome for bronchopleural fistula.

Bronchopleural fistula: Single axial CT scan of the chest with IV contrast in the same patient shows a metallic valve within a right segmental bronchus, which has been placed to help treat the bronchopleural fistula.

 

This patient had a chronic, non-remitting hydropneumothorax, which did not resolve even after the placement of the bronchial valve. This is concerning for a bronchopleural fistula.

A bronchopleural fistula is simply defined as an abnormal connection between an airway and the pleura, which is a space between the lung parenchyma and chest wall. There are two layers of pleura, including the parietal pleura abutting the chest wall and the visceral pleura, which lines the lung parenchyma. Normally the pleura contains a small amount of fluid. In the case of bronchopleural fistula, the pleura will fill with air and fluid, as seen in the image above. Bronchopleural fistulas can be seen after pneumonectomy or as a complication of empyema.

This bronchopleural fistula was chronic, which can be delineated from the first CT image above given the pleural thickening. It was treated with a metallic bronchial one way valve, which was ineffective. Bronchopleural fistulas can be further treated with an omental flap at the site of fistulization.

Read about pleural effusions here.