Bronchopleural fistula is a medical condition characterized by an abnormal connection between the bronchus and the pleural cavity and it is a pathological condition in the body.
Bronchopleural fistula leads to a high mortality rate as well as morbidity. The percentage of mortality is between 40% and 80%.
It is mainly caused by a cancer of the lung as well as the aftermath of chemotherapy or radioactive treatment of cancerous cells.
Diagnosing and managing bronchopleural fistula has always been a major challenge for doctors. To get an accurate diagnosis for bronchopleural fistula, the CT test is used.
The treatment usually involves doing a repair on the abnormal fistula created, using an endoscope to examine the part of the body affected through a process called endoscopy, visualizing the bronchus in a process called a bronchoscopy, a surgery may also be carried out on the chest.
All the above are techniques and methods available for the treatment and management of bronchopleural fistula.
People who suffered from lung cancer are more at risk of developing the condition compared to people who have not suffered from lung cancer.
Symptoms of Bronchopleural Fistula
Mostly bronchopleural fistula is asymptomatic, the symptoms do not necessarily show on the patients. Patients can be diagnosed after bronchoscopy or endoscopy which shows that air leaks through the connection created to the pleural cavity.
For the fact that a connection like this is created the chances of air breathed into the lungs passing through the connection in the pleural cavity.
Most times symptoms presented can be overlooked because they are almost the same with symptoms seen in a patient after lung cancer and these symptoms are always persistent cough with thick pinkish-sputum, passing out blood when the patient coughs, difficulty in breathing, etc.
Causes of Bronchopleural Fistula
There seems to be a variety of causes of bronchopleural fistula but the most prominent among them is the aftermath of lung resection cancer.
Other causes may include;
- Necrosis caused by infection of the lung
- Chemotherapy treatments during lung cancer
- Air in the pleural cavity a condition called Pneumothorax
- Tuberculosis has also been seen to be a major cause of bronchopleural fistula
- Surgical operation performed on the lung to remove it or remove a part of the lungs a condition known as pneumonectomy which can lobectomy or segmentectomy.
- Intense smoking can cause COPD (Chronic Obstructive Pulmonary Disease)
- Poor nutrition
- Lack of proper wound healing capability
- Lung cancer
- Cancer in the esophagus
All the above listed are major contributing factors and causes of bronchopleural fistula and it is also important to know that it majorly occurs after either surgically removing the lungs or a part of it(Pneumonectomy), removing one lobe of the lungs (Lobectomy) or removal of a segment of the lobe of the lungs(Segmentectomy)
Abnormal Physiological Changes Caused by the Disease (Pathophysiology)
Bronchopleural fistula cause after operations can either be acute, chronic as well as Subacute. Acute Bronchopleural fistula needs emergency surgery as delay may decrease the chances of survival. Acute BPF is a threat to life and patients with the acute condition is characterized by;
- Constant air leak from the pleural cavity
- Reduction of pleural effusion
- Persistent cough marked by the passage of sputum
- Breathing difficulties.
The subacute and chronic forms of BPF is mostly caused by infection of the airways and are mostly present in patients who have weak or inefficient immune systems and protection.
It can also be seen in patients who have other related medical conditions co-occurring at the same time with the primary condition. Subacute bronchopleural fistula is also characterized by fever and malaise.
Chronic fistula occurs mostly as a result of infections as well as thickening of the tissues of the pleural cavity, a condition called Fibrosis.
After lung cancer surgery can occur most often within 9-12 days.
If it happens within the first few days post-operation then the cause is most probably to be as a result of the failure to properly perform a bronchial stump which is always mechanical.
When this happens a reexploration of the bronchial stumping is required.
Incidence of Bronchopleural Fistula
There has been a lot of researches involving the occurrence of bronchopleural fistula and most of them if varies from each other.
These researches were always aimed at finding the actual incidence of BPF mostly after lung cancer and chemotherapy or radiation treatment,
Well the incidence, is now seen to around 2% and 28% of lung cancer surgeries and treatments as well as infections of the airways.
Bronchopleural fistula as mentioned earlier occurs between 9-12 days after surgery and is more likely to occur following extensive surgeries involving the removal of the right side of the lungs.
It can also occur following high does of radiation administered to the patient before the actual surgery.
Stated earlier that BPF occurs within 9-12 days postoperative procedure, but it is also important to know that it can occur earlier or even 1 month after lung cancer surgery.
Bronchopleural fistula is mostly diagnosed using findings and results from radiological testing and CT scan is the preferred testing for BPF.
The CT scan may show increased retention of air or fluid in the pleural cavity and this is a positive test for BPF.
Your doctor will most probably suspect BPF when there is a persistent air leak from the pleural cavity, this is to say that your doctor discovers the fistula by his inability to remove the chest tube used in surgery due to persistent air leak from the pleural.
There may also be persistent bubbling of air and an air leak only occurs during forced respiration (inspiration or expiration).
Treatment and Management of Bronchopleural Fistula
The treatment of bronchopleural fistula is always very important and should be approached with every swiftness and accuracy, this is because the mortality rate for this condition is very high as well as the morbidity.
In the treatment of BPF, three major approaches are employed;
- Drainage of the accumulated fluid in the pleural cavity.
- Repairing the fistula
- Removal of the pleural cavity
1. Drainage of the accumulated fluid in the pleural cavity.
Drainage of the accumulated fluid in the pleural cavity involves the use of a needle inserted carefully into the cavity of the chest and gradually draining the fluid out into a syringe after which testing of the fluid is required to determine the cause of accumulation. This can also be done using a tube inserted into the chest cavity.
Before this is done local anesthesia will be administered as this will make the treatment less painful and discomforting.
Many a time pain killers will be also administered to help ease the pain and discomfort.
2. Repairing the fistula
Repairing the fistula follows immediately after suction of the fluid from the pleural cavity and it aims at repairing the fistula using endoscopy techniques which is safer and more reliable.
Repairing the fistula regardless of the technique used still requires that the fluid in the cavity be drained first and antibiotics administered.
During bronchoscopy, the fistula is first assessed and then glues and sealants are introduced into the fistula.
This causes inflammation of the fistula leading to scarring and most importantly closure of the fistula.
3. Removal of the pleural cavity
In some cases, the pleural cavity is removed entirely and this is to prevent the accumulation of fluid or air in the cavity.
This is one of the 3 treatments involved in the treatment o bronchopleural fistula.
It involves pleurodesis which is a medical technique that attempts to get the layers of the pleura to come together hence eliminating the space between them, the pleural cavity.
Before the procedure is performed, a general ana anesthetic and often very successful in general except if there are multiple areas of effusion.
Pleurodesis is performed on a patient once in his lifetime.
During this procedure, a chemical is introduced into the cavity using a tube, these chemicals will cause inflammation which in turn causes scarring which now holds the two pleural spaces together such that fluid can no longer build-up.
Also Read: Bump On Gums: Causes And Treatment Options
- Bronchopleural fistula has a high morbidity and mortality rate
- It can occur between 9-12 days after surgery
- It can as well occur 1 month after surgery
- The major causes of BPF includes, lung cancer, pneumothorax, tuberculosis, etc
- BPF can be diagnoses by persistent cough marked by the passage of think purulent sputum or blood, breathing difficulties, etc.
- It can be diagnosed using either physical examination or CT scan
- The treatment of bronchopleural fistula includes drainage of fluid from the cavity, repairing the cavity and removal of the pleural cavity.