Bronchopleural Fistula Causes and Treatment

Illustration of lungs

Dorling Kindersley / Getty Images 

Table of Contents
View All
Table of Contents

A bronchopleural fistula (BPF), also known as a bronchopleural air leak, is an abnormal passageway that develops between the large airways in the lungs (the bronchi) and the space between the membranes that line the lungs (the pleural cavity).

BPF is a serious complication often caused by lung cancer surgery. It can also develop after chemotherapy, radiation, or an infection. While life-threatening, the survival rate is between 73% and 90%.

This article looks at the symptoms and causes of bronchopleural fistula, how common it is, and how it's diagnosed and treated.

Symptoms of Bronchopleural Fistula

When a bronchopleural fistula develops, air that you breathe into your lungs can travel through it and enter the pleural space.

When a BPF does cause symptoms, they're similar to what's expected following lung infections and surgery. They include:

  • Persistent cough
  • Coughing up a clear to pink, frothy fluid if it's within two weeks of surgery
  • Coughing up a pus-like fluid if it develops later
  • Coughing up blood
  • Shortness of breath

A BPF doesn't always cause symptoms, though. When it's asymptomatic, the diagnosis is often made after an imaging study reveals a persistent air leak.

Causes of Bronchopleural Fistula

Several conditions can cause a bronchopleural fistula.

Lung Cancer Surgery

Pulmonary resection (removal of all or part of a lung) for lung cancer is by far the most common cause of a bronchopleural fistula.

BPF is most likely after a pneumonectomy (complete removal of a lung). In one study, 1.4% of lobectomies (partial removal) and 14.3% of pneumonectomy led to a BPF.

It is also more common in those who have right-sided lung surgery.

Other Causes

  • Chemotherapy or radiation therapy for lung cancer, as they both cause tissue damage
  • Infection, especially with some types of pneumonia that destroy tissues (called lung necrosis)
  • Persistent spontaneous pneumothorax, which is a collapsed lung that doesn't go away on its own
  • Tuberculosis

How Common Is Bronchopleural Fistula?

Studies vary when looking at how common bronchopleural fistulas are. But it appears to occur in between 1.5% and 28% of surgeries involving lung removal.

It's also more likely to occur:

  • After extensive surgeries
  • After right-sided pneumonectomy
  • When mechanical ventilation is needed for a prolonged period following surgery
  • When high doses of radiation are given before surgery

Most often, a bronchopulmonary fistula occurs one to two weeks after lung surgery. However, it may occur even a month afterward.

Diagnosis of Bronchopleural Fistula

Healthcare providers usually diagnose bronchopleural fistulae based on radiological findings. A CT scan is often the test of choice. It may show increased air or fluid (often pus) in the pleural space.

A bronchopleural fistula is often discovered when providers can't remove a chest tube after lung surgery due to a persistent air leak. There may be continuous bubbling, or an air leak may be present only when you breathe in or breathe out.

With a small air leak, bubbling may only be present during forced exhalation or a cough.

Treatment of Bronchopleural Fistula

Three major steps—each a separate surgical procedure—are involved in treating a bronchopleural fistula.

  1. Draining the fluid that's accumulated in the pleural cavity
  2. Repairing the fistula
  3. Pleurodesis (joining the pleural membranes together) to get rid of the pleural cavity so fluid can no longer accumulate

Bronchopleural Fistula Repair

Fistula repair may be done: surgically or endoscopically

  • Surgically
  • Endoscopically, with a scope and camera inserted into your digestive tract through your nose or mouth, and glues or sealants to close the passageway

Recent studies suggest endoscopic procedures may be both safer and more effective for most people. If your condition isn't stable, the endoscopic method may be the only suitable approach.

Surgery is never used to treat a bronchopleural fistula caused by infection.


A bronchopleural fistula is an abnormal passage between the bronchi (airways in the lungs) and the pleural cavity (space between membranes lining the lungs). It's a serious complication caused by surgery, cancer treatment, or infection.

A BPF is life threatening but has a survival rate of at least 73%. Symptoms are a persistent cough, possibly with blood, pus, or a pink frothy fluid. It doesn't always cause symptoms.

BPFs are diagnosed with a CT scan. They're treated with fluid drainage, repair of the fistula, and sealing the pleural membranes together to prevent fluid accumulation.

A Word From Verywell

If you suspect a BPF, call 911 or get to an emergency room right away. If you've had surgery or are otherwise at risk for one, make sure the people taking care of you at home know the signs to watch for.

Frequently Asked Questions

  • Does a bronchopleural fistula cause pneumothorax?

    Yes, it can. It's rare, though, and is usually associated with prior chemotherapy and radiation. The type of cancer most likely to lead to a BPF is Hodgkin's lymphoma.

  • How can a bronchopleural fistula be prevented?

    Healthcare providers can prevent BPFs by:

    • Taking extra care with people whose immune systems are compromised or suppressed
    • Addressing possible malnutrition before surgery
    • Avoiding mechanical ventilation with positive pressure after lung resection
    • Protecting the bronchial blood supply during surgery
    • Avoiding an over-long bronchial stump during lung resection
    • Ensuring the pleural space isn't contaminated during surgery
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhang C, Pan Y, Zhang RM, Wu WB, Liu D, Zhang M. Late-onset bronchopleural fistula after lobectomy and adjuvant chemotherapy for lung cancer: A case report and review of the literatureMedicine (Baltimore). 2019;98(26):e16228. doi:10.1097/MD.0000000000016228

  2. Ahn JY, Kim D, Hong JM, Kim SW. A recurrent empyema with peripheral bronchopleural fistulas treated by retrograde bronchial sealing with Gore Tex plugs: a case report. J Thorac Dis. 2015;7(12):E657-61. doi:10.3978/j.issn.2072-1439.2015.11.33

  3. Fuso L, Varone F, Nachira D, et al. Incidence and management of post-lobectomy and pneumonectomy bronchopleural fistula. Lung. 2016;194(2):299-305. doi:10.1007/s00408-016-9841-z

  4. Tsubakimoto M, Murayama S, Iraha R, Kamiya H, Tsuchiya N, Yamashiro T. Can peripheral bronchopleural fistula demonstrated on computed tomography be treated conservatively? A retrospective analysis. J Comput Assist Tomogr. 2016;40(1):86-90. doi:10.1097/RCT.0000000000000328

  5. Ota T, Suzumura T, Sugiura T, et al. Spontaneous pneumothorax due to bronchopleural fistula following reirradiation for locoregionally recurrent squamous cell lung cancerClin Case Rep. 2016;4(5):481-485. Published 2016 Apr 1. doi:10.1002/ccr3.547

  6. Teh E, West D. Bronchopleural fistula: prevention is still best. Shanghai Chest. 2017;1(6). doi:10.1186/s13019-022-02032-0

Additional Reading

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."