CT of esophageal-pleural fistulae

Diagnosis of esophageal-pleural fistulae may be difficult in the absence of mediastinitis. To determine the value of CT in establishing this diagnosis and in detecting mediastinal involvement, CT findings in seven patients with esophageal-pleural fistulae were studied retrospectively. The fistulae were secondary to surgery (five patients), esophageal dilatation (one patient), and esophageal carcinoma (one patient). CT findings included barium, air, and fluid in the pleural space and pneumonia. These abnormalities seemed to distinguish an esophageal fistula from other pathologic processes, such as aspiration pneumonia, lung abscess, spontaneous pneumothorax, pulmonary emboli, and bronchopleural fistulae, and they documented a lack of inflammatory reactions in the mediastinum associated with the fistula. The latter finding is important, because patients with esophageal-pleural fistulae without mediastinitis have a less severe clinical course and respond better to conservative treatment. CT is useful for patients with normal findings on esophagrams when suspicion of esophageal-pleural fistulae remains high and when satisfactory esophagrams cannot be obtained.