title: Can Peripheral Bronchopleural Fistula Demonstrated on Computed Tomography be Treated Conservatively? A Retrospective Analysis.
abstract: OBJECTIVE
  Peripheral bronchopleural fistulas (BPF) are communications between a peripheral bronchus or the lung parenchyma and the pleural space. Although reported cases with peripheral BPF might have typical symptoms, we postulate that there may be BPF patients without typical symptoms who are diagnosed on computed tomography (CT) for the first time.
  
  
  METHODS
  We searched retrospectively for how frequently BPF is found on CT in cases with known or suspected empyema or hydropneumothorax. Also, we examined the clinical charts to ascertain if a diagnosis of BPF was suspected in the CT reports or clinically, and to determine the outcome of each case.
  
  
  RESULTS
  Thirteen thoracic cavities of 12 patients were included in this study. Of these, BPF was suspected clinically in only 1. Mention in the CT report about the presence of BPF was found in 2 cases. An apparent finding of BPF on CT was found in 7 of 13 (53%) thoracic cavities of 6 cases. The outcomes were that 1 patient died 1 month later due to multiple organ failure, and 1 patient was discharged subsequently after CT. In the other 10 cases, there was no exacerbation of the symptom regardless of definite evidence of BPF on CT.
  
  
  CONCLUSIONS
  In conclusion, when there is hydropneumothorax on CT, it is important for radiologists to diligently search for findings of peripheral BPF and to document it. However, a reference about the need for a surgical approach for BPF may not be required.
authors.affiliation: From the Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara-cho, Okinawa, Japan.
authors.forename: Maho
authors.initials: M
authors.lastname: Tsubakimoto
authors.forename: Sadayuki
authors.initials: S
authors.lastname: Murayama
authors.forename: Rin
authors.initials: R
authors.lastname: Iraha
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kamiya
authors.forename: Nanae
authors.initials: N
authors.lastname: Tsuchiya
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Yamashiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D001995:Bronchography; D005260:Female; D005402:Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D006872:Hydropneumothorax / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000000981:diagnostic imaging; D010995:Pleural Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult