Acquired tracheoesophageal fistula

Case contributed by Dr Andrea Andreone

Presentation

Patient with known oesophageal neoplastic lesion located in the proximal third. Solid dysphagia. Patient was referred to our interventional unit for RIG positioning.

Patient Data

Age: 60 years
Gender: Male

Preoperative CT showing circumferential lesion located at the proximal esophageal third

DSA (angiography)

In order to obtain a proper gastric distension, a 4F multipurpose catheter over an hydrophilic guide wire was advanced inside the esophagus; at the level of the lesion the guide wire stopped, so a tiny amount of iodinated contrast was injected. 

The patient immediately coughed, and tracheo-bronchial wall opacification was visible.

Then the guide wire was advanced and it passed inside the bronchial lumen (images not shown).

After several attempts, the guide wire was successfully pushed inside the gastric lumen and RIG positioning was performed.

X-ray

A few days later an esophagogram with diluted barium was performed, confirming the presence of opacification of right distal bronchi, due to the presence of a tracheo-esophageal fistula.

Case Discussion

Tracheo-esophageal fistulas are rare complications of intubation or malignant lesions.

The diagnosis of tracheo-esophageal communication was certain as the guide wire passed from the esophagus to the bronchial lumen.

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Case information

rID: 57747
Published: 26th Jan 2018
Last edited: 9th Oct 2018
Inclusion in quiz mode: Included
Institution: University of Parma

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