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Multiple infectious esophageal fistulae
Abstract:
Acquired fistulous communication between the respiratory tract and the esophagus in the adult are most often posttraumatic or secondary to malignant disease. Infectious fistulae, although uncommon, have been described secondary to primary esophageal, mediastinal, or pulmonary processes. Because of better mucosal definition, double contrast esophagography may help determine the origin of the communication and therefore aid in the differential diagnosis. In addition, near-maximal esophageal distension may demonstrate additional fistulae, which if widely separated, suggest an infectious etiology. To our knowledge, no examples of multiple esophagopulmonary communications have been reported in the English literature. We report two such cases in which the barium study correctly predicted an infectious etiology.
Insights
Acquired fistulous communication between the respiratory tract and esophagus is often due to trauma or cancer. Double contrast esophagography can identify infectious causes, especially when multiple fistulae are present.
Area of Science:
- Gastroenterology
- Pulmonology
- Radiology
Background:
- Acquired fistulous communications between the respiratory tract and esophagus in adults are typically posttraumatic or malignant.
- Infectious etiologies are uncommon but can arise from esophageal, mediastinal, or pulmonary sources.
Observation:
- Double contrast esophagography offers improved mucosal definition for identifying the origin of esophagopulmonary communications.
- Near-maximal esophageal distension during esophagography can reveal multiple, widely separated fistulae, suggesting an infectious origin.
Findings:
- This study presents two cases of multiple esophagopulmonary communications, a previously unreported entity in English literature.
- Barium studies in these cases accurately predicted an infectious etiology for the fistulae.
Implications:
- Double contrast esophagography is a valuable tool in the differential diagnosis of esophagopulmonary fistulae.
- Identifying multiple, widely separated fistulae via esophagography may indicate an infectious process, guiding appropriate management.