In order to obtain a proper gastric distension, a 4F multipurpose catheter over an hydrophilic guide wire was advanced inside the esophagus; at the level of the lesion the guide wire stopped, so a tiny amount of iodinated contrast was injected.
The patient immediately coughed, and tracheo-bronchial wall opacification was visible.
Then the guide wire was advanced and it passed inside the bronchial lumen (images not shown).
After several attempts, the guide wire was successfully pushed inside the gastric lumen and RIG positioning was performed.