What Is a Bronchopleural Fistula?

Causes and Treatments for Bronchopleural Fistulas

stethoscope next to word fistula
What is a brochopleural fistula?. Istockphoto.com/Stock Photo©Sohel Parvez Haque

Definition: Bronchopleural Fistula

A bronchopleural fistula is an abnormal passageway (sinus tract) that develops between the large airways in the lungs (bronchial tree) and between the membranes that line the lungs (the pleural cavity). When a passageway like this develops, air that is breathed into the lungs can travel through the passageway and enter the pleural space.

Causes of a Bronchopleural Fistula

There are several conditions which can cause a bronchopleural fistula.

Some of these include:

  • Lung cancer surgery - Pulmonary resection (removal of a lung or part of a lung) is by far the most common cause. It is more likely to occur with a pneumonectomy (complete removal of a lung) than with procedures such as a lobectomy (removal of a lobe of the lung) or a wedge resection.
  • Infection (especially some types of pneumonia which result in a breakdown of tissue called lung necrosis.)
  • Persistent spontaneous pneumothorax - This refers to a collapsed lung (pneumothorax) which isn't going away.
  • Chemotherapy or radiation therapy for lung cancer - Any treatment which causes damage to cells and subsequent healing in the region of the pleural border may result in the formation of a fistula.
  • Tuberculosis.

How Common is a Bronchopleural Fistula?

Studies looking at the incidence of these fistulas vary, but it appears to occur in between 1.5 and 28 percent of surgeries involving removal of a lung.

As noted earlier, it is more likely to occur with more extensive surgeries and is more likely to occur after a right-sided pneumonectomy, when mechanical ventilation is needed for a prolonged period of time following surgery, and when high doses of radiation are given prior to surgery.

Symptoms and Diagnosis

A bronchopleural fistula is usually suspected clinically by noting a persistent air leak and by increased air or pus (empyema) in the intrapleural space.

A CT scan is the test of choice for diagnosing the condition.


Treatment may be done surgically, or endoscopically through a bronchoscopy tube (sometimes this is the only method available if the patient is unstable.)

  • Surgery may be used to close the fistula.
  • Bronchoscopy - In this procedure the fistula is accessed and glues or sealants are inserted to close the passageway. These chemicals cause inflammation in the fistula which leads to scarring and closure, effectively gluing the abnormal passage shut.


A bronchopleural fistula is a severe complication of lung cancer surgery with mortality (death) rates varying from 10 to 27 percent depending on the study.

Also Known As: bronchopleural air leak, BPF

Examples: Sam developed a bronchopleural fistula after his pneumonectomy for lung cancer, and needed to remain in the hospital longer than he had anticipated.


Birdas, T. et al. Risk factors for bronchopleural fistula after right pneumonectomy: does eliminating the stump diverticulum provide protection?. Annals of Surgical Oncology. 2012. 19(4):1336-42.

Boudaya, M. et al. Conservative management of postoperative bronchopleural fistulas. Journal of Thoracic and Cardiovascular Surgery. 2013. 146(3):575-9.

Lois, M. and M. Nagen. Bronchopleural fistuals: an overvoew of the problem with special focus on endobronchial management. Chest. 2005. 128(6):3955-3965.

Sirbu, H. et al. Bronchopleural fistula in the surgery of non-small cell lung cancer: incidence, risk factors, and management. Annals of Thoracic and Cardiovascular Surgery. 2001. 7(6):330-6.

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