Pediatric Bronchopleural Fistula

  • Etiology: Communication between bronchus and pleural space caused by necrotizing pneumonia or blunt trauma or chest tube
  • Imaging CXR: May first manifest as hydropneumothorax
  • Imaging CT:
    — Clear communication between air filled bronchus and air-fluid collection in pleural space
    — Difficult to diagnose on CT
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: Look for air bubbles coming from chest tube

Radiology Cases of Bronchopleural Fistula

CXR of bronchopleural fistula
CXR AP shows a large right pleural effusion with an air-fluid level within it – a hydropneumothorax – that is being drained by a chest tube.
CT of bronchopleural fistula
Axial CT without contrast of the chest shows consolidation of the right lower lobe with multiple air pockets within it giving the appearance of necrotic lung, a large loculated right empyema that contains an air pocket, and one of the air pockets in the right lower lobe appears to be in continuity with the air pocket in the pleural space suggesting the presence of a bronchopleural fistula.
CXR and CT of bronchopleural fistula
CXR AP (above) shows diffuse bilateral airspace disease and a right sided pneumothorax that is almost completely drained by a right chest tube. Axial CT with contrast of the chest (below left) shows air and fluid and a chest tube in the right pleural space and an enhancing rim sign of the pleura. There is also a bronchopleural fistula from the superior segment of the right lower lobe to the necrotic lung and pleural space (below right).