Presentation
Known for a tracheal tumor. Post cervical tracheotomy and tracheal repair. Persistent dysphagia and severe aspiration. Endoscopy showed a fistula proximal to the esophagus. Scan requested for further evaluation. Also known for a T-lymphoblastic lymphoma (T-LBL).
Patient Data
Oral contrast extravasation within the trachea at the level of T1-T2 with visualization of a fistulous tract between the esophagus and the trachea.
Accessory findings in keeping with cervical lymphoma:
- mediastinal mass infiltrates the inferior visceral and carotid spaces in contact with supra-aortic vessels
- multiple peri-centimetric adenopathies within the left inferior peri-vertebral space (level V), and right level III
Another accessory finding is the tracheostomy cannula is of suboptimal positioning, with its distal extremity within the anterior wall of the trachea.
Annotated images centered at the tracheo-esophageal fistula:
- Opacification of the fistulous tract between the cervical oesophagous and the trachea.
- Contrast within the trachea.
Case Discussion
Here is an example of an acquired tracheo-esophageal fistula. The use of gastrografin oral contrast opacified the fistulous tract and thus was essential to confirm the diagnosis.
Fluoroscopy is another appropriate modality to evaluate the site and extent of the fistula, as well as offering a dynamic evaluation of the esophagus.
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