PMC3959410_01
PMC3959410_02
Initial chest radiograph. Increasing areas of confluent airspace disease involving the right middle and lower lobes and stable patchy airspace opacities involving both lungs with stable reactive lymphadenopathy
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F1
Initial chest radiograph showed bilateral basilar airspace opacities worse on the right and blunting of the right costophrenic angle (Fig. 1).
CT enterography. Colobronchial fistula tract (arrows) coursing from hepatic flexure and extending on the liver anteriorly and eventually communicating to right lower lobe bronchus with surrounding lung consolidation. Figures A and B demonstrate gastrointestinal contrast in the lung parenchyma. Figures C and D show fistula tract containing contrast from colon over the right lobe of the liver
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F2
Bronchoscopy and sputum cultures grew polymicrobial enteric organisms and abdominal CT enterography was the diagnostic test that confirmed a right colobronchial fistula (Fig. 2) and also multiple other colonic fistulas.
Chest radiograph after recovery
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F3
Significant improvement was evident after a twenty pound weight gain, mild intermittent non-productive cough, no recurrence of fevers and malaise, and normalization of chest radiograph (Fig. 3).