Acquired tracheoesophageal fistula
Citation, DOI & case data
Postoperative interrogation of esophageal repair following a gunshot to the neck. The patient complained of coughing following swallowing.
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After initiating swallowing, the patient aspirated water-soluble low osmolar contrast via a 6 mm tracheoesophageal fistula at the level of the cricopharyngeal muscle (C7 vertebral level).
Aspiration is demonstrated by opacification of the trachea and bronchi.
A jet phenomenon was also demonstrated.
There is also some over-the-top aspiration.
3 case questions available
Tracheoesophageal fistula is infrequently seen but has grave consequences if the diagnosis is missed.
Patients may present with a range of symptoms including dysphagia, dysarthria, coughing following swallowing, local pain or swelling and other symptoms related to the initial injury or medical cause.1
Chest X-ray findings are non-specific but the most common findings are left sided pleural effusion and subcutaneous emphysema. 2
Complications include aspiration with or without pneumonia, pleural effusions and lung abscesses.
Therapeutic management is surgical. 1
- Gunn M, Clark R, Sadro C, Linnau K, Sandstrom C. Current Concepts in Imaging Evaluation of Penetrating Transmediastinal Injury. Radiographics. 2014;34(7):1824-41. doi:10.1148/rg.347130022 - Pubmed
- Katabathina V, Restrepo C, Martinez-Jimenez S, Riascos R. Nonvascular, Nontraumatic Mediastinal Emergencies in Adults: A Comprehensive Review of Imaging Findings. Radiographics. 2011;31(4):1141-60. doi:10.1148/rg.314105177 - Pubmed