PMC4899986_01
PMC4899986_02
PMC4899986_03
Photomicrograph of the specimen obtained from the proximal portion of the fistula shows a cartilage (arrows) associated with fibrous soft tissue and submucosal glands (arrowheads).
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fig1
CT images of the lower chest, abdomen, and pelvis. A. Axial image just above the diaphragm demonstrates a fluid-filled oval structure (arrow) in front of the esophagus. This structure is consistent with cystic dilatation of the proximal stump after surgery. B. At the level of the liver dome, a fluid-filled residual fistulous tract (arrow) extends into to the left hepatic lobe. C. Sagittal reformation image demonstrates cystic structure (black arrow) and residual fistulous tract (white arrow) extending from the mediastinal base into the liver.
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fig2
A fluid-filled tubular structure was seen, extending from the cystic structure at the mediastinal base through the esophageal hiatus and into the liver (Fig. 2).
PMC4899986_04
PMC4899986_05
Cholangiogram demonstrates dilated intrahepatic bile ducts (short arrow) and residual fistulous tract (arrow head) with cystic dilatation (long arrow) at the mediastinal base. Contrast extravasation is seen in the liver parenchyma (double arrows). There is a severe stricture at the level of the common hepatic duct (open arrow), corresponding to the hypoplasia of common hepatic duct. There is no communication between the cystic dilatation and the trachea or bronchus.
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fig3a
There was also a markedly dilated residual tract of fistula connecting the left intrahepatic bile duct to the cystic dilatation of the proximal stump in the base of the mediastinum (Fig. 3A). Therefore, an additional right-sided transhepatic drainage catheter was placed through the residual fistulous tract with the pigtail formed in the cystic portion at the mediastinal base (Fig. 3B).
PMC4899986_06
PMC4899986_07