Acquired Tracheobronchoesophageal Fistulae

Tracheobronchoesophageal fistulae may be congenital or acquired.95,96 The most common congenital tracheoesophageal fistula, accounting for 80 to 90% of cases, is esophageal atresia with a low tracheoesophageal

figure 4-67 Tracheobronchomalacia. Inspiratory (A) and expiratory (B) computed tomography scans of the main bronchi reveal marked collapse of the bronchi on expiration. There is also diffuse thickening and calcification of the airways, typical of relapsing polychondritis.

Calcification Bronchus

figure 4-68 Congenital "H-type" esophagobronchial fistula. A, Posteroanterior chest radiograph demonstrates right basilar pneumonia and right hilar adenopathy in a patient who experienced recurrent pneumonia in the right lung. B, A barium esophagogram demonstrates a small fistula extending from the distal esophagus to a right lower lobe bronchus.

figure 4-69 Esophagobronchial fistula and broncholith due to histoplasmosis. An esophagogram (A) reveals an esophagobronchial fistula extending from the distal esophagus to the bronchus intermedius, and as demonstrated by a chest computed tomography scan (B), this patient had a broncholith (arrow) in the bronchus intermedius.

figure 4-69 Esophagobronchial fistula and broncholith due to histoplasmosis. An esophagogram (A) reveals an esophagobronchial fistula extending from the distal esophagus to the bronchus intermedius, and as demonstrated by a chest computed tomography scan (B), this patient had a broncholith (arrow) in the bronchus intermedius.

fistula, presenting at birth. The "H-fistula" without atresia may be difficult to diagnose and may go undetected until adulthood (Figure 4-68). The majority of tracheobronchoesophageal fistulae in adults are acquired. Such acquired fistulae result from several causes, including 1) malignancy of the esophagus, trachea, bronchi, thyroid, and lymphomas; 2) radiation injury; 3) fungal infections such as histoplasmosis and actinomycosis, tuberculosis, syphilis, and bacterial infections (Figure 4-69); and 4) traumatic causes such as those from mechanical ventilation with cuffed tubes and indwelling nasogastric tubes, blunt or penetrating trauma, lye burns of the esophagus, instrumentation, or esophageal foreign bodies (Figure 4-70). The diagnosis of a fistula can be established with the judicious use of an esophagogram, using low osmolar contrast material. High osmolar contrast should be avoided, because if the lung becomes flooded with contrast, life-threatening pulmonary edema and bronchospasm may develop.

figure 4-70 Postintubation tracheoesophageal fistula. Anteroposterior view of an esophagogram reveals a fistula of the proximal esophagus extending to the trachea in a patient with a tracheostomy tube.

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Responses

  • largo
    How do you get bronchi thickening?
    3 years ago

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