Presentation
Presented with the history of leakage of semisolid foods and liquids from a left chest wall wound while swallowing.
Patient Data
Posterior esophageal wall defect is seen at the level of T4 vertebra. Air is seen in the posterior mediastinal compartment and extend to left pleural space and communicate to the body surface through a subcutaneous and skin defect at the level of 2nd left rib.
Left second rib erosion with soft tissue thickening of the left chest wall.
Adjacent pleural thickening with bilateral upper lobe Architectural distortion
Multiple enlarged mediastinal lymph nodes
Multiple enlarged left axillary lymph nodes.
Right central venous catheter
Post-oral contrast (diluted low osmolar) shows a track lined by contrast from the posterior esophageal wall at the site of the defect to the left anterior chest wall.
Conclusion:
Features are consistent with an esophagocutenous fistula with secondary chest wall chronic osteomyelitis.
Case Discussion
This patient had a history of pulmonary tuberculosis three years ago. Tuberculous infection of the esophagus is a rare entity, it occurs in less than 0.2% of tuberculosis patients. Esophagocutaneous fistula is considered an extremely rare complication of tuberculosis esophageal infection with only 6 cases reported in the literature so far.
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