Bronchoesophageal fistula: An unusual manifestation of lung cancer

Smith, Chelsea; Bannon, Mark; Ashraf, Adrita; Kaushik, Prashant; Marak, Creticus P.

doi:10.1016/j.rmcr.2022.101634

Cited by 4 publications

(10 citation statements)

References 15 publications

(22 reference statements)

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“…However, definitive treatment often depends on addressing the underlying cause, especially when malignancy is involved. Multidisciplinary management involving gastroenterologists, pulmonologists, thoracic surgeons, and oncologists is essential for optimizing outcomes in patients with BEF [ 6 ]. Here, we present a case of aspiration pneumonitis secondary to BEF in a young female ultimately diagnosed with poorly differentiated squamous cell carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Unmasking the Invisible: A Case Study of Aspiration Pneumonia Unveiling a Bronchoesophageal Fistula

Sindhu,

Jadhav,

Ghewade

et al. 2024

Cureus

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Bronchoesophageal fistula (BEF) is a rare, yet clinically significant, condition characterized by an abnormal connection between the bronchial tree and the esophagus. We present the case of a 25-year-old female who initially presented with symptoms of aspiration pneumonitis and was subsequently diagnosed with BEF, attributed to poorly differentiated squamous cell carcinoma. Despite initial attempts at palliative intervention through esophageal stent placement, persistent symptoms prompted further investigation, revealing the underlying malignancy. This case underscores the diagnostic challenges associated with BEF, particularly when malignancy is involved, and emphasizes the importance of a multidisciplinary approach in optimizing patient outcomes. Early recognition, thorough evaluation, and comprehensive oncological management are essential in addressing the clinical complexities posed by BEF. Further research is warranted to better understand the pathophysiology and optimal management strategies for this rare but clinically significant condition.

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Section: Introductionmentioning

confidence: 99%

Unmasking the Invisible: A Case Study of Aspiration Pneumonia Unveiling a Bronchoesophageal Fistula

Sindhu,

Jadhav,

Ghewade

et al. 2024

Cureus

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“…In adults, congenital fistulas are quite rare; therefore, the occurrence of such cases usually suggests an acquired condition of benign (infections, chest traumatic events, prolonged endotracheal intubation) or malignant (esophagus, bronchi, mediastinum, lungs) origin [1,2]. Malignancy-associated broncho-esophageal fistulas may occur due to tumor infiltration and subsequent rupture, or as a result of radiation, laser therapy, chemotherapy, pre-existing stents (particularly esophageal stents), or a combination of these factors [3]; however, compared to tracheoesophageal fistulas, they are much rarer, with very few cases reported in the medical literature, which makes their diagnosis either delayed or inaccurate [4]. Additional causes of delayed diagnosis are the nonspecific and common symptoms such as cough, dysphagia, signs of aspiration, chest pain, or gastroesophageal reflux that may, however, severely impact the patient's quality of life [5].…”

Section: Introductionmentioning

confidence: 99%

“…Additional causes of delayed diagnosis are the nonspecific and common symptoms such as cough, dysphagia, signs of aspiration, chest pain, or gastroesophageal reflux that may, however, severely impact the patient's quality of life [5]. Most malignant broncho-esophageal fistulas develop as a complication of esophageal cancer, being present in 5-10% of affected patients; in lung cancers, this complication is much less frequently encountered and develops mainly for squamous cell carcinomas [4]. Although rare, the condition may lead to major morbidity and increased mortality rates in patients, being a life-threatening complication due to the risk of the development of recurrent pulmonary infections and sepsis [4,6]; the underlying cause should always be investigated.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment should be initiated promptly following the confirmation of the diagnosis to avoid sepsis and aspiration; the therapeutic approach must consider the symptoms, the configuration and location of the fistula, as well as its extent [7]. In the case of small lesions, chemotherapy alone or combined chemo/radiation therapy can be sufficient for complete resolution [4]. Other potential treatments involve surgery, stenting (either esophageal or bronchial), and endoscopic procedures (tissue adhesives, clips) [8].…”

Section: Introductionmentioning

confidence: 99%

“…combination of these factors [3]; however, compared to tracheoesophageal fistulas, t are much rarer, with very few cases reported in the medical literature, which makes th diagnosis either delayed or inaccurate [4]. Additional causes of delayed diagnosis are nonspecific and common symptoms such as cough, dysphagia, signs of aspiration, ch pain, or gastroesophageal reflux that may, however, severely impact the patient's qua of life [5].…”

Section: Introductionmentioning

confidence: 99%

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A Successful Treatment of Broncho-Esophageal Fistula with Esophageal Stenting Using Direct Endoscopic Visualization

Banciu,

Aprotosoaie,

Vancea

et al. 2024

Medicina

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Broncho-esophageal fistula (BEF) is a severe yet relatively rare connection between the bronchus and esophagus usually caused by esophageal and pulmonary malignancies. We present a case report of a 49-year-old man diagnosed with terminal lung carcinoma who developed a BEF. The thoracic computed tomography scan detected a mass in the left bronchi that partially covers and disrupts the bronchial contour in certain regions and extends to the esophageal wall. After thoroughly evaluating alternative treatment approaches, we opt for the stenting procedure due to the advanced stage of the tumor and the significantly diminished quality of life. The treatment involves the use of a partially covered metal stent that is known to exhibit lower potential to migrate. The treatment is highly successful, resulting in a significant enhancement of the patient’s quality of life, a lengthening in his survival, and the ability to pursue additional palliative treatment options. In contrast to the typical prosthesis implantation, our procedure uses a direct endoscopic visualization for the proximal deployment of a partially covered stent, offering a cost-effective and radiation-free alternative that can be particularly beneficial for BEF patients in facilities without radiology services.

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A rare case of pulmonary mucormycosis and broncho‐esophageal fistula in a patient with poorly controlled diabetes

Poursadegh,

Shazdeh Ahmadi,

Oskouyan

et al. 2024

Clinical Case Reports

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Key Clinical MessageIn patients with poorly controlled diabetes, early recognition of rare fungal infections like pulmonary mucormycosis, especially when presenting with unusual complications such as broncho‐esophageal fistula, is critical. Prompt intervention with antifungal therapy and consideration for surgical debridement significantly impact outcomes. Multidisciplinary management is paramount for such complex cases.AbstractMucormycosis is a rare fungal infection caused by the Mucorales. This infection is mostly observed among those with poorly controlled diabetes or immunodeficiency. The most common presentation of the infection among those with poorly controlled diabetes is rhino‐orbit‐cerebral involvement. In this case report, we provide the history and outcome of a rare case of pulmonary mucormycosis in a patient with poorly controlled diabetes who was simultaneously diagnosed with broncho‐esophageal fistula. Our patient was a 32‐year‐old male with a history of poorly controlled diabetes. Over the months, he had complained of productive coughs and dyspnea, which had lately been joined by dysphagia. He also claimed to have lost considerable weight (10 kg) during the previous 3 months. Barium swallow showed an abnormal flow of contrast between the bronchus and esophagus, suggesting a broncho‐esophageal fistula. Computed tomography of the thorax revealed a broncho‐esophageal fistula between the left main bronchus (LMB) and esophagus. He had a bronchoscopy the next day, which revealed necrosis and a broncho‐esophageal fistula in the LMB. A bronchial biopsy showed typical hyphae with necrotic tissue, indicating mucormycosis. The patient's antimycotic medication (liposomal amphotericin) was started and a prompt surgery consult was ordered. The patient, however, passed away from massive hemoptysis. We described a rare case of pulmonary mucormycosis with broncho‐esophageal fistula in a patient with poorly controlled diabetes. The rarity of this combination highlights the associated diagnostic and treatment hurdles. Early detection, antifungal medication, as soon as possible surgical debridement of involved tissues, and a multidisciplinary approach could improve patient outcomes.

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Bronchoesophageal fistula: An unusual manifestation of lung cancer

Cited by 4 publications

References 15 publications

Unmasking the Invisible: A Case Study of Aspiration Pneumonia Unveiling a Bronchoesophageal Fistula

Unmasking the Invisible: A Case Study of Aspiration Pneumonia Unveiling a Bronchoesophageal Fistula

A Successful Treatment of Broncho-Esophageal Fistula with Esophageal Stenting Using Direct Endoscopic Visualization

A rare case of pulmonary mucormycosis and broncho‐esophageal fistula in a patient with poorly controlled diabetes

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