Acquired tracheo-oesophageal fistula
An acquired tracheo-oesophageal fistula refers to a pathological communication between the trachea and oesophagus due to a secondary cause
Acquired causes of tracheo-oesophagal fistulae can be divided into those that are related to malignancy (common) and those from other causes (uncommon).
- in the elderly, they are most frequently seen with an intrathoracic malignancy and are most commonly associated with malignancy of the oesophagus
- this is often from malignant tissue spreading to involve the tracheal or bronchial wall and with subsequent ulceration and necrosis of the malignant tissue leading to tissue breakdown and fistula formation.
Non-malignant causes: infrequent
- trauma (blunt, penetrating, or iatrogenic): e.g. gunshot wounds 3
- chronic inflammation: chronic infections - tracheal wall necrosis or necrotising inflammation is usually the cause for fistulization.
- post-tracheostomy 2
May show site and extent of direct communication in real time. Fluoroscopy allows for dynamic evaluation of oesophageal motility as well as evaluation of its lumen.
A routine CT study could miss fistulae if the fistula tract is collapsed. Therefore a CT oral contrast swallow study is often performed in these situations. A diluted preparation of a non-ionic iodinated contrast agent is recommended with patient given a mouthful bolus of the preparation and asked to swallow it promptly on instruction to do so during the scan. Ct may accurately show the extent of the fistulation as well as complication such as aspiration effects in the lungs.
On imaging consider delayed presentation of a congenital tracheo-oesophageal fistula .
- 1. Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology. 224 (1): 9-23. doi:10.1148/radiol.2241011185 - Pubmed
- 2. Sanwal MK, Ganjoo P, Tandon MS. Posttracheostomy tracheoesophageal fistula. Journal of anaesthesiology, clinical pharmacology. 28 (1): 140-1. doi:10.4103/0970-9185.92478 - Pubmed
- 3. Kanne JP, Stern EJ, Pohlman TH. Trauma cases from Harborview Medical Center. Tracheoesophageal fistula from a gunshot wound to the neck. AJR. American journal of roentgenology. 180 (1): 212. doi:10.2214/ajr.180.1.1800212 - Pubmed
- 4. Hegde RG, Kalekar TM, Gajbhiye MI, Bandgar AS, Pawar SS, Khadse GJ. Esophagobronchial fistulae: Diagnosis by MDCT with oral contrast swallow examination of a benign and a malignant cause. The Indian journal of radiology & imaging. 23 (2): 168-72. doi:10.4103/0971-3026.116562 - Pubmed
- 5. Chaky DM, Escamilla C, Sheridan PH, Deboer D. Adult Bronchoesophageal Fistula Diagnosed on Computed Tomography. Radiology case reports. 3 (2): 126. doi:10.2484/rcr.v3i2.126 - Pubmed