Tracheo-oesophageal fistula

Case contributed by RMH Report Writing

Presentation

Loss of weight. Right lower lobe cavitating lesion on previous imaging.

Patient Data

Age: 73-year-old
Gender: Male
CT

CT Chest, abdomen and pelvis

Large mass lesion centred 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 oesophagus. 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 liver contains no focal lesions. The portal and hepatic veins are opacified. No biliary tract dilatation. The gallbladder contains contrast probably due to a previous examination. The pancreas, spleen and kidneys are normal. 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. No para-aortic or pelvic lymphadenopathy. No free intraperitoneal fluid or gas. There is degenerative spondylosis in the thoracolumbar spine. No suspicious skeletal lesions.

CONCLUSION

  1. Large cavitating mass lesion centred on the right mainstem bronchus that is probably due to the primary lung cancer.
  2. Malignant broncho-oesophageal fistula and right hilar nodal metastatic disease.
  3. 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.

Case Discussion

Endoscopy revealed carcinoma of the trachea, with a fistula to the oesophagus.

A malignant primary oesophageal cancer with fistula to the trachea or a main bronchus can give a similar appearance.

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Case information

rID: 38962
Case created: 13th Aug 2015
Last edited: 20th Mar 2017
Tag: rmh
Inclusion in quiz mode: Included

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