Acquired tracheo-oesophageal fistula

Case contributed by Dr Hidayatullah Hamidi

Presentation

A 49 year old female with history of pulmonary tuberculosis presents with severe dysphagia for last two weeks.

Patient Data

Age: 49 years
Gender: Female
Barium

Upper GI barium study shows complete obliteration of the proximal esophagus with abnormal opacification of the right bronchial tree especialy the right lower lobe.

Necrotic nodal mass in the paratracheal chain extending inferiorly to the level of the carina. There is evidence of abnormal communication between the esophagus and trachea just above the level of the carina.

A cavitary lesion in the apical segment of the right upper lobe and a soft tissue density nodule with some speculated outlines in the posterior segment of the right upper lobe.

Aspirated contrast material is noted in bilateral lung lower lobes mostly on the right side.

Case Discussion

Nodobronchial and nodobronchoesophageal fistulas are commonly caused by mycobacterium tuberculosis infection. They are characterized by the presence of gas in cavitated hilar or mediastinal lymphadenopathy adjacent to the airways.

Malignant neoplasia, particularly oesophageal, are the most common cause of tracheo-oesophageal fistulas in adults.

Case contributed by Dr. Hidayatullah Hamidi and Dr. Najibullah Rasouly

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Case information

rID: 51356
Case created: 12th Feb 2017
Last edited: 7th Aug 2017
Inclusion in quiz mode: Included

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