ARRS 2022 Abstracts


E2088. Plugging the Hole in Knowledge About Bronchopleural Fistulas
  1. Stefan Brancel; Henry Ford Hospital
  2. David Spizarny; Henry Ford Hospital
Bronchopleural fistulas (BPFs) occur when a bronchus connects to the pleural space. They are an important cause of air leak after pulmonary surgeries and have a high morbidity and mortality. Radiology is crucial, as a pneumothorax or hydropneumothorax is often the first clue to the complication, and CT frequently shows the site of the air leak. Treatment for BPF, both traditional and innovative, causes imaging findings that radiologists should recognize and understand, especially so complications can be reported promptly.

Educational Goals / Teaching Points
We define BPFs as compared to alveolar-pleural fistulas. We discuss the risk factors for BPF, with the most prominent being prior lung surgery and bronchopleural infections. We identify imaging findings that suggest BPFs. BPFs that are not suitable for direct surgical closure can undergo a variety of bronchoscopic and non-closure surgical treatments, both traditional and innovative, including bronchoscopic plugging and pleural marsupialization. We the discuss how to identify these treatments and the complications that can occur.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We discuss the radiographic and CT findings of BPFs, which include tension pneumothorax, pleural air-fluid levels, increasing air in the pleural space, and direct identification of bronchopleural fistula. We show and describe the radiographic and CT appearances of a variety of bronchoscopic treatments for BPF, including bronchial plugs and endobronchial valves. We show and describe radiographic and CT appearances of surgical treatments, including Clagett and Eloesser thoracostomies.

BPFs are an important cause of morbidity and mortality after lung resections and bronchopleural infections. Because radiology plays an important part in diagnosing these complications, radiologists need to understand when BPFs are suspected. Radiologists need to understand the imaging findings of innovative and traditional treatments to accurately evaluate and report the post-treatment findings.