Peripheral bronchopleural fistula: CT evaluation in 20 patients with pneumonia, empyema, or postoperative air leak.

PURPOSE: To assess the usefulness of standard and thin-section computed tomography (CT) in the examination of patients with possible bronchopleural fistulas (BPFs). MATERIALS AND METHODS: Twenty patients with known or suspected BPFs underwent CT. Twelve had pleural air and fluid collections; eight had air leaks. Fourteen patients also underwent thin-section CT. RESULTS: The BPF or its probable cause was visualized in all patients with air and fluid collections and in two of the patients with air leaks. BPFs due to bronchiectasis, necrotizing pneumonia, or alveolar cell carcinoma were identified in 10 patients. In four others, bronchiectasis was seen but the actual communication was not. In seven patients with postoperative air leaks, standard or thin-section CT demonstrated the air-leak source in only one. Thin-section CT was superior to standard CT in six of eight patients in whom the BPF or its probable cause was visible. CONCLUSION: Standard and thin-section CT are useful in the diagnosis and management of peripheral BPFs.