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Tracheopleural and esophagopleural fistula complicating corrosive-induced esophageal cancer
ARTICLE IN PRESS
Tracheopleural and esophagopleural fistula complicating corrosive-induced esophageal cancer Luis Gorospe, MD,a Alberto Caba~ nero-Sanchez, MD,b Gemma Marıa Mu~ noz-Molina, MD, PhD,b David Salda~ na-Garrido, MD,b Ana Patricia Ovejero-Dıaz, MD,b and Percy Carvajal-Serrano, MD,b Madrid, Spain
From the Departments of Radiologya and Thoracic Surgery,b Ramo n y Cajal University Hospital, Madrid, Spain
WE DESCRIBE THE IMAGING FINDINGS OF A TRACHEOPLEURAL AND AN ESOPHAGOPLEURAL FISTULA complicating a squamous cell esophageal carcinoma in a patient with human immunodeficiency virus with chronic esophageal strictures secondary to accidental caustic ingestion as a child. The esophageal cancer was diagnosed by an upper endoscopy after a thoracic computed tomography (CT) performed because of fever, malaise, and chest pain showed signs of esophageal perforation with mediastinitis
and a right pneumothorax. Thoracic CT demonstrated 2 fistulous tracts connecting the posterior tracheal wall and the right lateral wall of the esophagus with the right pleural cavity (Fig). The patient was given broad-spectrum antibiotics and underwent operative debridement of the mediastinum, but an operative closure of the esophagopleural fistula was not feasible at that moment. Unfortunately, the patient died from respiratory sepsis 8 days later.
Fig. (A) Axial thoracic CT image (lung window) shows a fistulous tract (black arrows) between the posterior wall of the trachea (T) and the right pleural cavity (asterisk). Note the presence of a nasogastric tube in the esophagus (white arrow). (B) Axial thoracic CT image (lung window) shows a fistula (black arrows) between the right wall of the mid-esophagus (white arrow) and the right pleural cavity (asterisk). Accepted for publication June 5, 2017. Reprint requests: Luis Gorospe, MD, Department of Radiology, Ram on y Cajal University Hospital, Ctra. de Colmenar Viejo Km 9.100, Madrid 28034, Spain. E-mail: [email protected]. Surgery 2017;j:j-j. 0039-6060/$ - see front matter Ó 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2017.06.002
The development of esophageal cancer in patients with a history of ingestion of a corrosive agent is well known. Patients with human immunodeficiency virus also face a greater risk for esophageal cancer. The diagnosis of corrosive esophageal cancer is more difficult than de novo (noncorrosive induced) esophageal cancer because SURGERY 1
ARTICLE IN PRESS 2 Gorospe et al
of preexisting symptoms of dysphagia and because endoscopic evaluation not always is possible due to severe esophageal luminal narrowing. To our knowledge this is the first case of a corrosiveinduced esophageal cancer presenting with a tracheopleural and esophagopleural fistula.1,2
Surgery j 2017
REFERENCES 1. Noh SY, Kim HJ, Lee HJ, Park SH, Lee JS, Kim AY, et al. Corrosive-induced carcinoma of esophagus: esophagographic and CT findings. AJR Am J Roentgenol 2017;23:1-7. 2. Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013;19:3918-30.
Tracheopleural and esophagopleural fistula complicating corrosive-induced esophageal cancer Luis Gorospe, MD,a Alberto Caba~ nero-Sanchez, MD,b Gemma Marıa Mu~ noz-Molina, MD, PhD,b David Salda~ na-Garrido, MD,b Ana Patricia Ovejero-Dıaz, MD,b and Percy Carvajal-Serrano, MD,b Madrid, Spain
From the Departments of Radiologya and Thoracic Surgery,b Ramo n y Cajal University Hospital, Madrid, Spain
WE DESCRIBE THE IMAGING FINDINGS OF A TRACHEOPLEURAL AND AN ESOPHAGOPLEURAL FISTULA complicating a squamous cell esophageal carcinoma in a patient with human immunodeficiency virus with chronic esophageal strictures secondary to accidental caustic ingestion as a child. The esophageal cancer was diagnosed by an upper endoscopy after a thoracic computed tomography (CT) performed because of fever, malaise, and chest pain showed signs of esophageal perforation with mediastinitis
and a right pneumothorax. Thoracic CT demonstrated 2 fistulous tracts connecting the posterior tracheal wall and the right lateral wall of the esophagus with the right pleural cavity (Fig). The patient was given broad-spectrum antibiotics and underwent operative debridement of the mediastinum, but an operative closure of the esophagopleural fistula was not feasible at that moment. Unfortunately, the patient died from respiratory sepsis 8 days later.
Fig. (A) Axial thoracic CT image (lung window) shows a fistulous tract (black arrows) between the posterior wall of the trachea (T) and the right pleural cavity (asterisk). Note the presence of a nasogastric tube in the esophagus (white arrow). (B) Axial thoracic CT image (lung window) shows a fistula (black arrows) between the right wall of the mid-esophagus (white arrow) and the right pleural cavity (asterisk). Accepted for publication June 5, 2017. Reprint requests: Luis Gorospe, MD, Department of Radiology, Ram on y Cajal University Hospital, Ctra. de Colmenar Viejo Km 9.100, Madrid 28034, Spain. E-mail: [email protected]. Surgery 2017;j:j-j. 0039-6060/$ - see front matter Ó 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2017.06.002
The development of esophageal cancer in patients with a history of ingestion of a corrosive agent is well known. Patients with human immunodeficiency virus also face a greater risk for esophageal cancer. The diagnosis of corrosive esophageal cancer is more difficult than de novo (noncorrosive induced) esophageal cancer because SURGERY 1
ARTICLE IN PRESS 2 Gorospe et al
of preexisting symptoms of dysphagia and because endoscopic evaluation not always is possible due to severe esophageal luminal narrowing. To our knowledge this is the first case of a corrosiveinduced esophageal cancer presenting with a tracheopleural and esophagopleural fistula.1,2
Surgery j 2017
REFERENCES 1. Noh SY, Kim HJ, Lee HJ, Park SH, Lee JS, Kim AY, et al. Corrosive-induced carcinoma of esophagus: esophagographic and CT findings. AJR Am J Roentgenol 2017;23:1-7. 2. Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013;19:3918-30.