Bronchopulmonary fistulas in children: a description of 9 clinical cases

Abstract

A bronchopulmonary fistula (BPF) is an abnormal communication between the bronchial tree and the pleural space. It´s development is associated with severe lung disease, pulmonary surgery and procedures that cause lung injury. We present a serie of 9 children, 7 girls, with BPF. The average age was 2 years, range 7 days to 7 years. BPF was associated with severe lung disease in 6 children (complicated pleuro-pneumonia in 4, severe bronchial obstruction in 1 and ARDS in 1). In 3 children BPF was a complication of lobectomy due to a congenital lung malformation and bronchiectasis. Clinical presentation was recognized by the sudden onset of dyspnoea and the development of a tension pneumothorax in 4 cases and recurrent pneumothorax in 5. BPF was associated with mechanical ventilation in 5 cases and post-thoracocentesis in 2 children with pleuropneumonia. The management was pleural drainage and in patients on mechanical ventilation, adjusted pressure in order to decrease the air leak, in 2 cases high-frequency ventilation was indicated. The closure of BPF was surgical in 6 cases, 4 with severe lung disease and 2 with lobectomy. In conclusion, in our serie BPF developed in children with severe lung disease requiring mechanical ventilation or as a complication of pulmonary surgery.