Esophageal-pleural fistula
Esophageal
emergencies: another important cause of acute chest pain. Esophageal fistulas. a Esophago-pleural fistula in a 61-year-old male with squamous cell carcinoma of mid esophagus, status post esophagectomy and gastric pull through presenting with fever. Axial CT image obtained 12 days after surgery shows a fistula (arrowheads) between the gastric tube and the right pleural space. Fluid collection with pleural enhancement and thickening (arrow) is suspicious for empyema. Reprinted with permission from Kim et al. Radiographics 2007; 27(2):409-429. b Aorto-esophageal fistula in a 70-year-old male patient with hypertension and regular alcohol use presenting with hematemesis and melena. Axial image of CT chest angiography shows type B aortic dissection with rupture, communication, and extravasation between aorta and esophagus (blue arrow) in the arterial phase. Reprinted from Kokatnur. Indian J Crit Care Med. 2015;19(2):119–121
An esophageal-pleural fistula refers to an abnormal connection between the esophagus and pleura.
Pathology
They can arise from a number of underlying pathologies which can result in an esophageal rupture :
- post surgical
- endoscopic procedures
- post esophageal dilatation
- secondary to a tumor, e.g. esophageal carcinoma
- esophageal tuberculosis
- from chemical injury following ingestion of corrosive substances
- from irradiation
Radiographic features
CT
Thoracic CT with esophageal (oral) contrast may show a direct communication with the pleural space. Air in the pleural space +/- hydropneumothorax in correct clinical setting may also be useful in the diagnosis.
Siehe auch:
Assoziationen und Differentialdiagnosen zu ösophagopleurale Fisteln:
