Conservative therapy consists of pleural fluid drainage, mechanical ventilation, nutritional support and the use of antibiotics, and this therapeutic approach is more common when bronchopleural fistula occurs as a result of infections. However, the drainage of pleural fluid can also favor the formation of new fistulas
Fistula
A fistula is an abnormal connection between two hollow spaces, such as blood vessels, intestines, or other hollow organs. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation. Fistulas are generally a disease condition, but they may be surgically created for therapeutic reasons.
What are the treatment options for bronchopleural fistula?
Treatment involves repairing the fistula, which may be done via endoscopy, bronchoscopy, or open chest surgery. A bronchopleural fistula does not always cause symptoms, and the diagnosis may be made in people who are asymptomatic after an imaging study reveals a persistent air leak.
How is postpneumonectomy bronchopleural fistula prevented?
To prevent postpneumonectomy bronchopleural fistula, coverage of the bronchial stump is recommended, especially for patients with high risk of BPF. Pedicled intercostal and extrathoracic muscles, diaphragm, pericardium, pericardial fat pad, and pleura can be used to make a flap to coverage the bronchial stump [ 30, 31, 32 ].
What causes 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) for lung cancer is by far the most common cause of a bronchopleural fistula.
What is the prognosis of bronchopleural fistula?
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. With prompt recognition and conservative treatment, it's likely that the prognosis of bronchopleural fistulas will improve.
What causes a Bronchopleural fistula?
A bronchopleural fistula may be caused by: (1) rupture of a lung abscess, bronchus, bulla, cyst, or parenchymal tissue into the pleural space; (2) the erosion of a bronchus by carcinoma or chronic inflammatory disease; or (3) stump dehiscence of a bronchial suture line after pulmonary resection.
How can Bronchopleural fistula be prevented?
Once in the operating room, meticulous surgical techniques should include protection of bronchial vascular supply and avoiding an over-long stump. Reinforcement of the stump using vascularized tissue and ensuring that the pleural space is not contaminated during surgery reduce the risk of developing BPF.
Does Bronchopleural fistula cause the pneumothorax?
Sole COVID-19 pneumonia can cause bronchopleural fistula, which leads to persistent pneumothorax.
What causes a lung fistula?
Causes. Pulmonary arteriovenous fistulas are usually the result of abnormal development of the blood vessels of the lung. Most occur in people with hereditary hemorrhagic telangiectasia (HHT). These people often have abnormal blood vessels in many other parts of the body.
How do you fix a Bronchopleural fistula?
BPFs do not typically spontaneously undergo closure and almost always require some surgical or bronchoscopic intervention. All patients with a BPF should have a chest tube placed to drain air. In cases of an empyema, infected pleural fluid should be drained, and antibiotics should be initiated.
What is bronchopleural?
Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and pleural space. This clinical condition, which has high mortality and morbidity, is one of the major therapeutic challenges for clinicians even today.
When do you need a bronchoscopy?
Common reasons for needing bronchoscopy are a persistent cough, infection or something unusual seen on a chest X-ray or other test. Bronchoscopy can also be used to obtain samples of mucus or tissue, to remove foreign bodies or other blockages from the airways or lungs, or to provide treatment for lung problems.
What is decortication surgery?
Decortication is a type of surgical procedure performed to remove a fibrous tissue that has abnormally formed on the surface of the lung, chest wall or diaphragm. Generally, there is a space (called pleural space) in between the lungs and the chest wall, which is lined with a very thin fluid layer for lubrication.
Why is pleurodesis performed?
Pleurodesis is a procedure performed to obliterate the pleural space to prevent recurrent pleural effusion or pneumothorax or to treat a persistent pneumothorax.
What is an AV fistula surgery?
An AV fistula is a surgically placed "shunt"; that is, an artery is directly sutured to a vein. An artery is a high-pressure vessel that carries blood away from the heart and delivers nutrients and oxygen to the tissues.
Where does a pulmonary arteriovenous fistula most often occur?
Pulmonary arteriovenous fistulas develop as the child develops in the womb. These abnormal vessels carry blood out of the lung before it is oxygenated—that is, replenished with oxygen.
What is a pulmonary fistula?
Pulmonary arteriovenous fistulas (PAVFs) are rare vascular malformations of the lung. There is a strong association with Rendu-Osler-Weber disease. Although most patients are asymptomatic, PAVFs can cause dyspnea from a right-to-left shunt. They can also bleed and result in hemoptysis and hemothorax.