Esophago-pulmonary fistula manifesting as recurrent pneumonias and migrating mediastinal calcifications

Abstract

A 43-year old man presented with recurrent pneumonias, episodes of hemoptysis and an enlarging right lower lobe mass. A clear diagnosis was not previously established in spite of multiple radiological evaluations and biopsies. Meticulous review of his CT imaging showed that he had subcarinal calcification on his prior CT scans, which had decreased in size and now multiple new small areas of calcifications were seen in the right lower lobe lesion. An esophago-pulmonary fistula due to migration of mediastinal calcifications was suspected which was identified on careful review of the CT chest and confirmed by esophagogastroduodenoscopy. Patient had surgical repair with complete recovery.

Incidentally Diagnosed Esophago-Pulmonary Fistula on 18F-FDG PET/CT in a Case of Carcinoma Esophagus

“…4 Patients of EPF generally present with symptoms such as chronic cough, recurrent pulmonary infection, hemoptysis, and other nonspecific symptoms, which can cause delay in diagnosis. 5 Careful examination and early diagnosis have vital role in patient management. 1 There is no curative treatment of EPF.…”

“…The right lung is the favored site for disease spread from esophagus due to anatomical predilection, because the right pleura has direct contact with esophagus 4 . Patients of EPF generally present with symptoms such as chronic cough, recurrent pulmonary infection, hemoptysis, and other nonspecific symptoms, which can cause delay in diagnosis 5 . Careful examination and early diagnosis have vital role in patient management 1 .…”