Early detection of occult bronchopleural fistula after routine standard pneumonectomy

Objective: The aim of this study was to define symptoms and signs for early diagnosis of occult bronchopleural fistula (OBPF) after routine pneumonectomy. Patients and Method: From 1999 to 2003, 301 pneumonectomies for malignancy were performed. The records of these patients were retrospectively analyzed for several clinicopathologic factors. All patients (group A) that presented postoperatively with one or more suspicious symptoms and signs were recorded. These cases were grouped according to bronchopleural fistula documentation (group A1) or not (group A2). Both groups were subjected to multivariate analysis. Results: In 10 cases (3.3%) bronchopleural communication was confirmed (group A1). The most frequent signs included the lack of contracture or even enlargement of postpneumonectomy space (52.7%), subcutaneous emphysema (33.3%), fever (27.7%), respiratory insufficiency (27.7%), and cough (22.2%). Multivariate analysis disclosed failure of the postpneumonectomy space to contract as an independent prodromal sign for bronchopleural communication (p=0.03, odds ratio 58.3, 95% Cl: 1.45 - 2335.9). Conclusion: Chest radiology proved to be the diagnostic modality of choice for early detection of bronchopleural fistula.