Acquired tracheoesophageal fistula

Case contributed by Dr Desiré Ciske Havinga

Presentation

Postoperative interrogation of esophageal repair following a gunshot to the neck. The patient complained of coughing following swallowing.

Patient Data

Age: 30 years
Gender: Male
Fluoroscopy

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

 

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