Prise en charge des fistules pleurales

Pleural fistulas are characterized by a communication between the pleura and another structure. They can have various clinical forms and multiple locations. However, they have a common characteristic, namely pleural infection, and the occurrence of respiratory and nonspecific infectious symptoms. Among them, the bronchopleural fistula is the most frequent, and can occur in two circumstances:after pulmonary resection (mainly pneumonectomy), and in case ofpleuro-pulmonary infectious (particularly in the context of necrotizing pneumonia). Literature on pleural fistula consistis mainly of small series and cases reports, and no evidence based medicine guidelines are available. However, there are general principles of treatment, based on a multidisciplinary approach depending on the type of fistula (cause, topography) and patient status. Closed or open drainage (pleurostomy) of empyema is the mainstay of pleural fistulas treatment with, in a second time, a surgery to repair/resect lesions and possibly fill residual spacein case of open drainage.