A bronchopleural fistula involves an abnormal passageway or connection between the pleural cavity and the airways in the lungs. The condition can lead to symptoms like shortness of breath and coughing.

A bronchopleural fistula does not commonly develop. In some cases, a person may experience a bronchopleural fistula after they have some form of lung surgery. For example, it appears at a range of 0.5–1% after a lobectomy, which involves the removal of one lobe of the lung.

This article explores what a bronchopleural fistula is in more detail, including its symptoms, causes, and diagnosis. The article also discusses treatment options and outlook.

Image of a person exhaling while standing in area with treesShare on Pinterest
RealPeopleGroup/Getty Images

To understand what a bronchopleural fistula involves, it is helpful to understand lung anatomy.

The bronchial tubes, which healthcare professionals may refer to as bronchi, are the large airways that go to the lungs. Two layers of membranes line the lungs. The pleural cavity is the space between the two membranes. Normally, there is no passageway between the pleural space and the bronchi.

When someone has a bronchopleural fistula, a connection develops between the pleural space and bronchial tubes.

A bronchopleural fistula rarely develops after a person has a lobectomy. While still uncommon, it may occur more frequently after a pneumonectomy, which is when a surgeon removes an entire lung. The frequency range of a bronchopleural fistula developing after pneumonectomy is 4.5–20%.

In some cases, a bronchopleural fistula does not cause symptoms. Someone may only know they have it after an imaging test shows an air leak in their lungs.

Doctors classify a bronchopleural fistula as:

  • acute
  • subacute
  • chronic

An acute bronchopleural fistula usually occurs following lung surgery and can become life threatening. A chronic or subacute bronchopleural fistula typically develops due to infection and happens more slowly.

Possible symptoms include:

According to2017 research, the incidence of bronchopleural fistulas has decreased due to improvements in tuberculosis (TB) treatment and lung surgery techniques. However, they can still occur for a number of reasons.


Surgery to treat lung cancer is the most frequent cause of a bronchopleural fistula. These surgeries may include a lobectomy or a pneumonectomy.

According to a small 2016 study, 2.2% of people developed a bronchopleural fistula after lung cancer surgery. The rate of bronchopleural fistula was 1.4% in the group that had a lobectomy, and 14.3% in those who had a pneumonectomy.

A bronchopleural fistula may develop at any time after lung surgery. But most often it develops within the first 8–12 days after the procedure.


Significant lung infections can also damage the lung tissue and may lead to a bronchopleural fistula. For instance, a 2022 case study involved a person who had treatment for a bronchopleural fistula after they had a COVID-19 infection.


TB may possibly cause bronchopleural fistula is TB. This condition is more prevalent in low or middle income countries.

Doctors may diagnose a bronchopleural fistula after completing a physical exam, and ordering and reviewing imaging tests, such as a CT scan.

A healthcare professional may use a CT scan to create pictures of the lungs and chest cavity, which may show an air leak in the lungs.

Doctors may also order a bronchoscopy to make a diagnosis. A bronchoscopy involves a healthcare professional inserting a scope with a camera attached into a person’s airways and lungs. This allows physicians to determine the location and size of a fistula, which can help them plan treatment.

Treating a bronchopleural fistula may depend on the severity of a person’s symptoms, size of the fistula, and overall health. Treatment options may include:

  • Chest tube placement: Chest tube placement involves a doctor inserting a tube into a person’s chest to drain air and fluid from the pleural space. A person may require this procedure after surgery to treat a fistula.
  • Antibiotics: A person may develop an infection due to a bronchopleural fistula. Doctors may recommend broad-spectrum antibiotics to treat the infection.
  • Surgery: A healthcare professional’s decision to perform surgery and what type of procedure may depend on the location and size of the fistula. They may perform an open chest procedure or perform surgery during bronchoscopy. The goal is to repair the fistula.

The outlook for people who develop a bronchopleural fistula may depend on how soon their treatment starts and the fistula size. People may need an extended hospital stay.

The mortality rate ranges from 18–67%. Typically, when a bronchopleural fistula leads to death, it is due to respiratory distress syndrome. People at an increased risk of death after developing a bronchopleural fistula may include those who had larger air leaks and those who required mechanical ventilation.

Additionally, procedure success rates vary. For example, the successful repair rate using bronchoscopy management ranges from 30–80%.

Depending on the treatment a doctor recommends, recovery may include antibiotic treatment, placement of a chest tube, and close monitoring to identify a recurrence.

A bronchopleural fistula is an abnormal passageway between the bronchial tubes and the pleural space in the lungs.

A complication from surgery to treat lung cancer is the main cause of a bronchopleural fistula. Although the condition does not commonly occur, it can be life threatening.

Treatment may include surgery to close the fistula and management of any infections or symptoms.