PMC6224867_01
Chest radiograph demonstrating bilateral opacities in both mid to upper lung fields consistent with changes from silicosis. Calcified hilar lymph nodes, consistent with granulomatous disease from silicosis, are also seen bilaterally. Note a nasogastric tube is also in place.
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F1
On chest radiograph, there were bilateral calcified hilar lymph nodes and opacities in the mid to upper lung fields consistent with his diagnosis of silicosis (Figure 1).
Upper gastrointestinal series demonstrating a widely patent fistula between the mid-esophagus and bronchus intermedius (arrow), with contrast extending into the right lower-lobe bronchi (left bottom) as well as the esophagus and stomach (right bottom). Mediastinal calcifications consistent with silicosis are also seen.
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F2
A formal barium upper GI swallow study demonstrated a widely patent fistula between the mid-esophagus and bronchus intermedius, with contrast extending into the right lower-lobe bronchi (Figure 2).
Coronal segment of a contrast-enhanced chest CT scan revealing an open bronchoesophageal fistula (8-mm wide) (F) at the subcarinal level involving the right bronchus intermedius (B) and extending into the esophagus (E) with retained contrast visualized. Extensive enhancing calcified lymph nodes (asterisk) are seen bilaterally throughout the anterior and middle mediastinum and hilar regions.
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F3
Chest computed tomography confirmed an 8-mm fistula extending from the subcarinal region into the esophagus, with progressive massive fibrosis and traction bronchiectasis in the upper lobes (Figure 3).