Presentation
Postoperative interrogation of esophageal repair following a gunshot to the neck. The patient complained of coughing following swallowing.
Patient Data
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.
Case Discussion
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