CTICasesBronchopleural Fistula
Imaging findings
CT of the chest in a patient presenting with necrotizing consolidation of the left lung shows a massive, loculated hydropneumothorax with extensive gas bubbles in the pleural space prior to any intervention. Follow-up scans after chest tube drainage show persistent pleural gas and direct communication between subpleural airways and the pleural space (bronchopleural fistula). The cavity is subsequently obliterated using a pectoralis muscle flap.
Key takeaways
A bronchopleural fistula (BPF) is a communication between the biliary/bronchial tree and the pleural space, which can be caused by necrotizing infections (such as Fusobacterium necrophorum aspiration pneumonia), trauma, or surgery. The presence of gas within a loculated pleural collection prior to intervention is highly suggestive of BPF or infection by gas-producing organisms. Treatment requires adequate drainage, antibiotics, and often surgical muscle flap transposition to obliterate the space.
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