Introduction
Bronchopleural fistula is fistulous communication
between pleural cavity and bronchial tree secondary to some disease process or
injury. Though the x-ray can raise suspicion of the diagnosis but the CT scan
is preferred because it not only important in localisation of the
broncho-pleural fistula but also in finding out the probable etiological
factor.
Figure 1: Diagnosis is
bronchopleural fistula.
Case Report
A 54 year old man was not able to maintain saturation
CECT thorax shows connection (arrow) between left upper lobe segmental bronchi
and pleural space having air-fluid level. There is presence of loss of volume
on left side and also there is a cavitatory lesion in left apices with
aspergilloma in it. Diagnosis is bronchopleural fistula [1-6].
Discussion
Bronchopleural fistula is fistulous communication between pleural cavity and bronchial tree secondary to some disease process or injury. It can be central when the pleural cavity communicates with trachea or lobar bronchus and peripheral when occur with segmental bronchi. It may present with fever, chest pain, dyspnoea and hypoxia. Falling fluid level along with expectoration of purulent or serosanguinous material is seen.
Key imaging diagnostic
clues
· Actual
connection may be demonstrated though rarely seen, but drop in fluid level is
seen after pneumonectomy.
· Development
of hydropneumothorax without any intervention or procedure.
Differentials
Gas forming organisms
causing infection in pleural space Hydropneumothorax- may be iatrogenic.
References
- Stern EJ, Sun
H, Haramati LB. Peripheral bronchopleural fistulas: CT imaging features. Am J
Roentgenol. 1996; 167: 117-120.
- Tsubakimoto
M, Murayama S, Iraha R, Kamiya H, Tsuchiya N, Yamashiro T. Can peripheral bronchopleural
fistula demonstrated on computed tomography be treated conservatively? A
retrospective analysis. J Comp Assisted Tomography. 2016; 40: 86.
- Sutton
D. Text Book of Radiology and Imaging. Churchill Livingstone. London. 2003; 2:
1453-1487.
- Adam A, Dixon
AK, Gillard JH, Schaefer-Prokop C, Grainger RG, Allison DJ. Grainger &
Allison's Diagnostic Radiology E-Book. Elsevier Health Sciences; 2014.
- Gupta AK,
Garg A, Khandelwal N. Diagnostic Radiology: Gastrointestinal and Hepatobiliary
Imaging. JP Medical Ltd; 2017.
- Haaga JR, Boll D. Computed tomography & magnetic resonance imaging of the whole body e-book. Elsevier Health Sciences; 2016.