Following are the main differentiating features of bronchopleural fistula versus lung abscess on plain radiographs and CT 1:
Bronchopleural fistula
- bronchopleural fistulas have mostly lenticular shape of space
- length of gas-fluid level in bronchopleural fistula in different projections is unequal
- contiguous to chest in at least one projection and make an obtuse angle (>90 degrees)
- split pleura sign is often present
- displace vessels and airways
- thin, uniform, smooth walls on both aspects
- adjacent consolidation may be absent
- sometimes extend into costophrenic angle
- may cross fissures
- sometimes change shape of space with posture
Lung abscess
- lung abscesses are spherical
- length of gas-fluid level in lung abscesses in different projections is approximately equal
- often separate from chest on all aspects and make acute angle (<90 degrees)
- does not show split pleura sign
- does not displace vessels and airways
- thick, non uniform and irregular wall on both aspects
- adjacent consolidation is usually present
- does not extend into costophrenic angle
- does not cross fissures
- does not change in shape of space with posture
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