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Radiographic signs in post pneumonectomy bronchopleural fistula.

Four instances of bronchopleural fistula (BPF) occurred in three patients following right pneumonectomy. In all, a striking increase in air content and fall in the fluid level of the pleural space provided to be diagnostic. The radiologic diagnosis of BPF requires monitoring of the air-fluid level in the pneumonectomy space, using a horizontal beam to demonstrate the changing volume of air and fluid regardless of the patient's position. One patient presented with a tension pyopneumothorax without good clinical evidence of BPF and required prompt chest tube drainage for the relief of severe dyspnea; mediastinal shift had occurred toward the remaining lung. Mediastinal shift did not occur in the other patients.