Alveolar-pleural fistula (APF) and bronchopleural fistula (BPF) are uncommon yet frustrating medical and surgical problems with high morbidity and mortality. They may originate spontaneously or be encountered after bronchoscopy or thoracic surgery. However, they are almost always caused by an underlying pulmonary pathology, which seems to be the most important prognostic factor.
Reparative surgeries are never a desired first therapeutic option for APF or BPF. Pleurodesis with chemicals such as talc and thoracic surgery have had high failure rates.1 Unfortunately, pleural and bronchscopic interventions have had limited success as well. Bronchoscopic options for APF and BPF have been marred by technical problems, although their conceptual foundation is appealing. Airway occluding devices and agents have been used for decades. These modalities include endobronchial Watanabe spigots (Novatech), gelfoams, endobronchial valves, and synthetic hydrogel.