PMC6451813_01
Chest X-ray showing cavitary opacity in the right upper lung field.
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Initial chest X-ray revealed a prominent right upper lobe cavitary lesion (Figure 1).
Contrast-enhanced CT scan. Axial section (neck) showing airspace consolidations with diffuse tree in bud opacities in the right lung apex and to a less extent, in the left lung apex. In addition, there are multiple areas of cavities within the right lung apex.
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Further workup was obtained with a CT chest, which showed "tree-in-bud" opacities in bilateral lung fields, along with "thick walled" cysts of the right upper lobe (Figure 2).
Esophagogastroduodenoscopy (EGD). The upper esophagus at 25 cm showed a 2.5 cm defect with a visible fistulous track to the trachea.
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Follow-up studies with an esophagogastroduodenoscopy (Figure 3) and bronchoscopy (Figure 4) revealed bronchoesophageal fistulas, which were presumed to be a result of MTB infection.
Bronchoscopy. Bronchoesophageal fistulas with openings seen in the right mainstem bronchus on the posterior aspect right below the carina at around 6'o clock position.
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Follow-up studies with an esophagogastroduodenoscopy (Figure 3) and bronchoscopy (Figure 4) revealed bronchoesophageal fistulas, which were presumed to be a result of MTB infection.
Bronchoscopy (posttreatment). There are two healed fistulas in the right posterior mainstem (posterior to carina), measuring approximately 0.5 cm each.
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He was reevaluated with a bronchoscopy (Figure 5), which showed interval healing of the bronchoesophageal fistulas.