Algorithm for the Bronchoscopic Diagnosis of Alveolar-Pleural Fistula

Area of Science:

• Pulmonology
• Thoracic Surgery
• Medical Imaging
• Endoscopy

Background:

• Alveolar-pleural fistulas (APF) present significant diagnostic and therapeutic challenges in clinical practice.
• Accurate anatomical localization of APF is crucial for effective management, especially in patients unsuitable for surgery.

Purpose of the Study:

• To design and evaluate a diagnostic algorithm for the anatomical detection of alveolar-pleural fistulas (APF).
• To identify effective diagnostic methods for patients who are not candidates for surgical treatment.

Main Methods:

• A prospective, non-randomized study involving 47 patients.
• Diagnostic procedures included computed axial tomography (CT), electronic pleural drainage (EPD), and endoscopic techniques: endobronchial occlusion (EO), selective endobronchial oxygen insufflation (OI), and selective bronchography (BS).
• Endoscopic procedures utilized continuous fluoroscopy for iodinated contrast instillation.

Main Results:

• Computed axial tomography (CT) identified the anatomical location of APF in 31.9% of patients.
• Endoscopic methods achieved anatomical determination of APF with varying success rates: EO (57.1%), OI (81%), and BS (63.4%).
• The combined diagnostic approach successfully located APF in 91.5% of the study sample, with a high safety profile (85.1% no complications).

Conclusions:

• Flexible bronchoscopy is a safe and effective method for diagnosing APF.
• The proposed algorithm integrates CT scans and EPD, with specific endoscopic recommendations based on air leak patterns (EO for continuous, OI for intermittent, BS as secondary).
• The diagnostic algorithm demonstrates high efficacy in determining APF location, aiding in treatment planning for non-surgical candidates.