PMC7990559_01
PA chest radiograph shows a left lower zone heterogeneous opacity silhouetting the left hemidiaphragm (yellow arrow) and a retrocardiac air lucency (red arrow).
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Initial chest radiograph (Figure 1) showed a left lower lung zone heterogeneous opacity silhouetting the left hemidiaphragm and left retrocardiac air lucency.
Coronal nonenhanced CT image of the lower chest and upper abdomen (soft tissue and lung window (a, b)) shows left lower lobe consolidation with cavitation (yellow arrow), communicating with the lumen of the gastric remnant (red arrow).
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A follow-up CT scan of the abdomen (Figure 2) was done to rule out an intra-abdominal fluid collection (oral contrast was not given as the patient was intolerant of oral intake) and showed a left lower lobe consolidation with cavitation and tract connecting it with the gastric remnant lumen.
Esophagogastroduodenoscopy (EGD) was performed which showed a large fistula orifice just below GEJ (arrow).
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The gastroenterology team was consulted, and esophagogastroduodenoscopy (EGD) confirmed the presence of a large fistula orifice just below the gastroesophageal junction (Figure 3).
A single-contrast upper GI study performed with a water-soluble contrast shows contrast leak (yellow arrow) extending upwards from the gastric remnant into the left lung base with contrast opacification of the left lower lobe peripheral bronchial branches (red arrow) producing a gastrobronchial fistula.
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