Asymptomatic esophageal carcinoma with esophagopulmonary fistula masquerading as a primary lung abscess

A 58-year-old man presented with the clinical signs and symptoms of a large right upper lobe lung abscess. His course was complicated by diffuse bilateral necrotizing pneumonitis, and death occurred as a result of massive aspiration of lung abscess contents into uninvolved lung. At postmortem examination, an esophageal carcinoma with a direct fistulous communication with the abscess cavity was present. Although rare, asymptomatic malignant esophageal disease should be considered in the differential diagnosis of a lung abscess which does not follow a typical course.