Unusual Presentation of an Esophagopleural Fistula in a Patient With Severe Esophagitis: Blunt Trauma or Iatrogenic?

Abstract

Esophagopleural fistula (EPF) is rare despite the anatomical proximity of the esophagus and the pleural space. A 64-year-old man presented with a pneumothorax after a fall requiring chest tube placement. An esophagogastroduodenoscopy revealed severe LA grade D esophagitis and a large EPF in the distal esophagus. Computed tomography scan revealed that subtle tracking of air extending from the distal esophagus into the right pleural space was noted. The patient was treated with placement of a fully covered esophageal metal stent, and he recovered uneventfully. Interpreting key subtle clues in pleural fluid analysis and imaging can lead to a timely diagnosis and thus improves morbidity and mortality of EPF.

Iatrogenic Esophagopleural Fistula After the Management of Acute Variceal Hemorrhage With Minnesota Tube Placement

“…1,2 Some of the etiologies include prior pneumonectomy, esophageal foreign body, and sequelae related to malignancies of the esophagus, lung, and mediastinum. 2,3 Clinical manifestations are nonspecific and include fever, subcutaneous emphysema, dyspnea, and pleural effusions. 2 Leakage of digestive contents into the sterile space of the mediastinum and pleura can lead to local response, including acute mediastinitis and pneumonia or systemic response, including sepsis and related shock.…”