Peripheral Bronchopleural Fistula: CT Evaluation in 22 patients

ABSTRACT

PURPOSE: To determine the usefulness of CT for the evaluation of peripheral bronchopleural fistulas. MATERIALS AND METHODS: CT scans of 22 patients with persistent air leak, as seen on serial chest PA, and aclinical history, were retrospectively evaluated. We determined the visibility of direct communication between thelung and pleural space, and the frequeucy and location of this, and if direct communications were not visualizedthe probable cause. RESULTS: A bronchopleural fistula(n=13) or its probable cause(n=6) was visualized in 19patients(86%). Direct communications between the lung and pleural space were seen in 13 patients(59%); there weresix cases of tuberculous empyema, three of tuberculosis, two of necrotizing empyema, one of trauma, and one ofpostobstructive pneumonitis. In six patients, bronchiectatic change in peripheral lung adjacent to the pleuralcavity was noted, and although this was seen as a probable cause of bronchopleural fistual, direct communicationwas invisible. Bronchopleural fistula or its probable cause was multiple in 18 of 19 patients, involving the upperand lower lobe in eight, the upper in nine, and the lower in two. CONCLUSIONS: CT is useful for evaluating thepresence of bronchopleural fistula, and its frequency and location, and in patients in whom the fistula is notdirectly visualized, the cause of this.