PMC8668381_01
PMC8668381_02
(
A
) Upper gastrointestinal (GI) contrast series shows reflux of contrast from stomach into the communication (arrow) between the right lung lower lobe and esophagus at T8-T9 level. These images were taken for bilious aspirates on day 8 of life and contrast was instilled via nasogastric tube. (
B
) Upper GI contrast series after the second surgery with oral contrast shows a second communication (long arrow) from the esophagus into the right lower lobe at T5-T6 level. Short arrow indicates communication at T8-T9 level. (
C
) Esophagoscopy image taken at the level of esophageal anastomosis shows the second communication from the esophagus into the right lower lobe at T5-T6 level (long arrow) and esophageal lumen in the right upper corner (short arrow). (
D
) A coronal section of computed tomography scan of chest wall shows the communications from esophagus to right lower lobe at T5-T6 level (long arrow) and T8-T9 level (short arrow).
10-1055-s-0041-1740321-i200532cr-1.jpg
PMC8668381_03_10-1055-s-0041-1740321-i200532cr-1.jpg
FI200532cr-1
The bronchoscopy findings were normal demonstrating no recurrent TOF, but the esophagoscopy showed an opening, discharging purulent material corresponding to the second communication from the esophagus into the right lower lobe at T5-T6 level ( Fig. 1B and C ) and a patent esophageal anastomosis. Subsequently computed tomography (CT) thorax confirmed two separate communications between the esophagus and right lung tissue, with an accompanying anomalous blood supply ( Fig. 1D ).
PMC8668381_03
(
A
) Upper gastrointestinal (GI) contrast series shows reflux of contrast from stomach into the communication (arrow) between the right lung lower lobe and esophagus at T8-T9 level. These images were taken for bilious aspirates on day 8 of life and contrast was instilled via nasogastric tube. (
B
) Upper GI contrast series after the second surgery with oral contrast shows a second communication (long arrow) from the esophagus into the right lower lobe at T5-T6 level. Short arrow indicates communication at T8-T9 level. (
C
) Esophagoscopy image taken at the level of esophageal anastomosis shows the second communication from the esophagus into the right lower lobe at T5-T6 level (long arrow) and esophageal lumen in the right upper corner (short arrow). (
D
) A coronal section of computed tomography scan of chest wall shows the communications from esophagus to right lower lobe at T5-T6 level (long arrow) and T8-T9 level (short arrow).
10-1055-s-0041-1740321-i200532cr-1.jpg
PMC8668381_03_10-1055-s-0041-1740321-i200532cr-1.jpg
FI200532cr-1
The bronchoscopy findings were normal demonstrating no recurrent TOF, but the esophagoscopy showed an opening, discharging purulent material corresponding to the second communication from the esophagus into the right lower lobe at T5-T6 level ( Fig. 1B and C ) and a patent esophageal anastomosis. Subsequently computed tomography (CT) thorax confirmed two separate communications between the esophagus and right lung tissue, with an accompanying anomalous blood supply ( Fig. 1D ).
PMC8668381_04
(
A
) This is the surgeon's view of posterolateral incision of right thoracotomy. Yellow loop encircles the esophagus. The esophageal anastomosis was intact. Red vessel loop encircles the anomalous vessels supplying to right lower lobe. Blue loop encircles esophageal connection that enters into the right lower lobe which is being retracted by retractors. (
B
) Postoperative upper gastrointestinal contrast image after definitive surgery.
10-1055-s-0041-1740321-i200532cr-2.jpg
PMC8668381_04_10-1055-s-0041-1740321-i200532cr-2.jpg
FI200532cr-2
The right lower lobe was separated from the esophagus, by ligating and dividing these two fistulous connections, which bore more resemblance to bronchial type tissue, followed by a partial lobectomy ( Fig. 2A ). A postoperative upper GI contrast series identified a patent esophageal anastomosis, no leakage, and no fistulous connections ( Fig. 2B ).