Tracheo-esophageal fistula and pneumonitis secondary to chicken bone

Case contributed by Dr Nolan Walker


Chicken bone seen in upper esophagus 2 weeks ago. Not removed. Now presenting with chest infection. Suspected paratracheal abscess

Patient Data

Age: 35 years
Gender: Female

Soft tissue window shows no paratracheal collection, but there is soft tissue thickening of the upper esophagus, subtle but visible.

There is also an abnormal horizontal bar of soft tissue attenuation in the trachea. This is best seen on the MIP sagittal images, where it can be more clearly appreciated as a bone.

The lung windows reveal bilateral centrilobular nodules in the right middle, left upper, and bilateral lower lobes with bibasal mucous plugging.

These findings are suggestive of a chemical pneumonitis secondary mucous aspiration as a result of the tracheo-esophageal fistula.


Case Discussion

Chicken bones are usually taken out if seen on naso-endoscopy/oesophagoscopy. However, in this case, they were not.

This CT study performed 2 weeks after chicken bone ingestion reveals that the chicken bone is best seen on the sagittal imaging. On the axial imaging, the chicken bone could be mistaken for a strand of saliva.

Chicken and fish bones are often not calcified. Traceho-eosophageal fistulation secondary to impaction of a foreign body is a recognized complication. In this case, a chemical pneumonitis had also developed.

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