Abstract
Introduction: Bronchopleural fistula (BPF) is an abnormal communication between the bronchial tree and the pleural space that is associated with considerable morbidity and mortality, particularly in settings with a high burden of pulmonary infection.
Objective: This review synthesizes current literature on the definition, etiology, pathophysiology, diagnosis, and management of BPF, with particular attention to its association with infectious and non-infectious lung disease.
Methodology: A literature review was conducted using peer-reviewed articles, case reports, and clinical guidelines retrieved from PubMed and other academic sources published between 2001 and 2025, with a focus on BPF etiology, classification, diagnostic modalities, and treatment approaches.
Findings: BPF is most commonly caused by pulmonary resection (lobectomy or pneumonectomy), with the right lung disproportionately affected due to its anatomical configuration. Infectious causes, particularly tuberculosis-related pyothorax and necrotizing pneumonia, remain leading contributors in tuberculosis-endemic regions such as Indonesia, while non-infectious causes include lung malignancy, chronic obstructive pulmonary disease, trauma, and iatrogenic injury. Diagnosis relies on a combination of clinical suspicion, radiographic findings, computed tomography, and bronchoscopy. Management follows a staged approach, beginning with non-invasive supportive measures such as chest tube drainage and progressing to invasive surgical repair, including thoracotomy, video-assisted thoracoscopic surgery, decortication, and, in resistant cases, open window thoracostomy.
Conclusion: BPF remains a diagnostically and therapeutically challenging condition whose management must be individualised according to onset, fistula size, and underlying etiology. Early recognition and a multidisciplinary approach are essential to reducing its associated mortality, particularly in areas affected by tuberculosis and limited healthcare resources.