Acquired tracheo-esophageal fistula
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Acquired causes of tracheo-esophageal 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, most commonly of the esophagus
- 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-malignancy related causes: infrequent
- trauma (blunt, penetrating, or iatrogenic) e.g. gunshot wounds 3
- chronic inflammation: chronic infections - tracheal wall necrosis or necrotizing inflammation is usually the cause for fistulization
- post-tracheostomy 2
Fluoroscopy may show the site and extent of direct communication in real time and it allows dynamic evaluation of esophageal motility as well as evaluation of its lumen.
A standard CT study could miss fistulae if the fistulous 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 the 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 complications such as aspiration.
- on imaging consider delayed presentation of a congenital tracheo-esophageal fistula
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