Bronchoscopic-Guided Selective Endobronchial Injection of Methylene Blue Solution for Localising Peripheral Bronchopleural Fistulas During Pleural Debridement in a Post-Lobectomy Patient With Bronchopleural Fistula and Empyema.

The bronchopleural fistula (BPF) is a pathological passageway between the bronchus and the pleural cavity. Diagnosing and localising BPF can be challenging, and the traditional retrograde methylene blue (MB) perfusion method may fail to identify multifocal BPFs. This article reports a novel method for locating multifocal BPFs in patients undergoing concurrent empyema debridement. Initially, selective endobronchial injection of MB solution is performed under bronchoscopic guidance. Subsequently, the thoracic surgeon determines the location of BPFs as the MB solution flows into the pleural cavity. This process of injecting MB within the bronchus is repeated to locate any additional BPFs until no new ones are found. We report a case where this new method was used to identify multifocal BPFs, ultimately diagnosing three BPFs' presence. Following treatment with bronchopleural fistula occlusion, no recurrence of BPFs was observed during the follow-up period.