Bronchopleural fistula corresponds to abnormal communication between the bronchi and the pleura, which is a double membrane that lines the lungs, resulting in inadequate air passage and being more frequent after lung surgery. Bronchopleural fistula is usually identified by signs and symptoms presented by the person and imaging tests, such as chest radiography and bronchoscopy.
This situation is rare and serious, especially when it occurs in children, and must be resolved quickly so as not to put the person's life at risk. Therefore, it is important that after lung surgery or when the person has any type of respiratory impairment, follow-up exams are carried out to check for any changes and, if necessary, to start treatment.
Causes of bronchopleural fistula
Bronchopleural fistula is more related to lung surgery, especially lobectomy, in which a lung lobe is removed, and pneumonectomy, in which one side of the lung is removed. In addition, it is common for bronchopleural fistula to occur as a consequence of necrotizing infection, in which due to the presence of the microorganism responsible for the infection, tissue death occurs. Other possible causes of bronchopleural fistula are:
- Pneumonia, the fistula being considered a complication of the disease, especially when caused by fungi or bacteria of the genus Streptococcus ; Lung cancer; After chemotherapy or radiation therapy; Complication of lung biopsy; Chronic smoking; Chronic obstructive pulmonary disease; Performing mechanical ventilation.
It is important that the cause of bronchopleural fistula is identified so that proper treatment is started and complications are avoided, such as difficulty in the breathing process, inadequate expansion of the lungs, difficulty in maintaining ventilation in the pulmonary alveoli and death.
How to identify
The diagnosis of bronchopleural fistula is made by the general practitioner or pulmonologist by means of imaging tests, such as chest radiography, in which atelectasis can be observed, which is a situation in which there is no air passage to a specific region of the lung, collapsing, or pulmonary detachment. In addition to radiography, the doctor must perform bronchoscopy, in which a small tube is introduced through the nose so that the structures of the respiratory system can be observed, and the location of the fistula and its size can be precisely identified.
In addition, the doctor must evaluate signs and symptoms presented by the person, such as coughing up blood or mucus, difficulty breathing and fever, being more common to be noticed after performing lung surgeries, whose symptoms appear about 2 weeks after the procedure.
Therefore, it is important that after respiratory surgery, the person is regularly monitored by the doctor in order to avoid the formation of fistulas and their complications.
How the treatment is done
Treatment for bronchopleural fistula varies according to the cause, the person's medical history and the signs and symptoms presented. Most of the time, treatment consists of performing surgery to resolve the fistula, however it is possible that after a while the fistula will reappear. Surgery is usually recommended in cases where conservative therapy does not have the desired effect, when there are signs indicating sepsis or when there is air leak.
Conservative therapy consists of drainage of the pleural fluid, mechanical ventilation, nutritional support and use of antibiotics, this therapeutic approach being more common when bronchopleural fistula occurs as a result of infections. However, drainage of the pleural fluid can also favor the formation of new fistulas. Therefore, the treatment for this situation is considered a challenge for medicine and regardless of the recommended treatment, it is necessary that the person is monitored regularly in order to assess the therapeutic success and the need for new interventions.
A new therapeutic approach that has been studied is the placement of mesenchymal stem cells in the bronchopleural fistula, which are cells capable of regenerating tissues and, therefore, can favor the closure of the fistula. However, it is not yet known how these cells act in the resolution of the fistula and nor would they have the same effect in all people. Therefore, further studies are needed to prove the effect of this type of treatment on bronchopleural fistulas.
