Bronchoesophageal Fistula, Manifestation of Lung Carcinoma

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Bronchoesophageal Fistula
Source: The New England Journal of Medicine
  • Bronchoesophageal fistula is a communication between the bronchus and oesophagus.
  • The condition is either congenital or acquired (incidence unknown).
  • Acquired cases can be because of malignancies, traumatic factors and infections.

This article describes a case of bronchoesophageal fistula due to a lung carcinoma in a 50-year-old male patient. The patient presented to the emergency department with complaints of shortness of breath, chest pain and a cough with a history of 5 days. He had been diagnosed with large-cell neuroendocrine carcinoma of the lung fifteen days before. In addition, the cancer had metastasised to the brain.

On examination, the patient’s oxygen saturation was 93% in ambient air quality. Physical examination was further remarkable of diminished breath sounds in the right lower lobe in addition to paroxysms of cough on fluid intake. For further evaluation, doctors advised a computed tomography of the chest. CT findings showed diffuse bilateral intestinal infiltrates and previously diagnosed lung lesion surrounding the middle third of the oesophagus. The patient tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The test results came back negative, ruling out SARS-CoV-2.

Doctors referred him for a water-soluble esophagography. Findings showed material passing from the esophagus into the right bronchial tree. The material ascended to the right main bronchus and trachea as the patient coughed (see video). The findings were consistent with the diagnosis of bronchoesophageal fistula due to lung carcinoma.

Treatment included placement of a covered, self-expanding stent in the oesophagus. It helped alleviate the patient’s cough and chest pain. His oncologist subsequently started him on chemotherapy. However, the patient did not show any improvement with treatment. Therefore, he was transferred to hospice care, where he died 4 weeks after presentation.

References

Bronchoesophageal Fistula https://www.nejm.org/doi/full/10.1056/NEJMicm2018535

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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