Acquired tracheo-esophageal fistula

Case contributed by Hidayatullah Hamidi
Diagnosis certain


History of pulmonary tuberculosis, presents with severe dysphagia for last two weeks.

Patient Data

Age: 50 years
Gender: Female

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

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 spiculated 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 esophageal, are the most common cause of tracheo-esophageal fistulas in adults.

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

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