Malignant broncho-esophageal fistula
Loss of weight. Right lower lobe cavitating lesion on previous imaging.
CT Chest, abdomen and pelvis
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Large mass lesion centered on the right mainstem bronchus measuring approximately 50 x 60 x 60 mm in maximum dimensions with invasion into the surrounding tissues, areas of central cavitation and a malignant fistula with the adjacent esophagus. Right hilar lymphadenopathy is noted measuring 12 mm in maximum short axis diameter.
There is a rounded mass lesion within the apical segment of the right lower lobe measuring 40 x 40 mm in maximum dimensions in contact with the posterior pleural surface, consistent with intrapulmonary metastatic disease. There is thickening of the subjacent pleura and another area of pleural thickening more superiorly, consistent with pleural metastatic disease.
The lungs demonstrate changes of centrilobular emphysema. There are small areas of patchy ground glass density within the right middle and upper lobes which may be due to evolving or resolving inflammation. A parenchymal band is noted right costophrenic angle. No axillary lymphadenopathy.
CT abdomen and pelvis
There is a mass lesion in the left adrenal gland measuring 28 x 26 mm consistent with metastatic disease. The right adrenal gland is normal.
The gallbladder contains contrast probably due to a previous examination. There is thickening of the right diaphragmatic crus measuring up to 20 mm in thickness, suspicious for metastatic disease. There is a prominent left para-aortic lymph node measuring 9 mm in axial short axis diameter. There is degenerative spondylosis in the thoracolumbar spine.
- Large cavitating mass lesion centered on the right mainstem bronchus that is probably due to the primary lung cancer.
- Malignant broncho-esophageal fistula and right hilar nodal metastatic disease.
- Evidence of intrapulmonary metastatic disease in the right lower lobe and metastatic disease involving the right pleura, left adrenal gland and probably the right diaphragmatic crus.
Endoscopy revealed carcinoma of the right mainstem bronchus, with a broncho-esophageal fistula. A malignant primary esophageal cancer with fistula to the trachea or a main bronchus can give a similar appearance.