A bronchopleural fistula (BPF) is an abnormal communication between the pleural space and primary bronchus. Although rare, it can be life-threatening. BPF most commonly occurs as a postoperative complication after pulmonary resection (usually pneumonectomy). Other causes include pulmonary barotrauma, penetrating chest trauma, rupture of a bulla, or rupture of a lung abscess into the chest cavity.

Look for cough and changes in the air-fluid pattern on chest radiography. Patients may also present with fever, serosanguinous or purulent sputum, acute respiratory distress syndrome, and empyema. BPF typically presents 7-15 days after pulmonary resection; delayed presentations occur less frequently. If it develops as a complication of pleuropulmonary infection, however, onset may occur at any point.

BPF is usually clinically apparent from history and presentation, although radiologic features may help identify its presence. However, locating the leak site of the BPF can sometimes pose a diagnostic challenge and may require multiple imaging procedures and repeated bronchoscopy.

The main management goal is to treat the patient's underlying disease and provide ventilator adjustments to minimize air leak. Treatment should be individualized to each patient and his or her clinical status.