PMC3616142_01
Initial radiological investigation. Chest x-ray (A) showed a mass in the right upper chest (arrow). Computed tomography scan (B) confirmed the mass (*) compressing the trachea (arrow head).
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A chest x-ray was obtained that showed a para-tracheal mass (Figure 1A). Computed tomography (CT) scan of the chest showed a large mediastinal mass partially compressing his trachea (Figure 1B).
Sequence of computed tomography (CT) scans following completion of chemo- and radiotherapy. Coronal view (A) of the first CT scan following completion of therapy showed a fluid collection in the right upper chest (*); axial view (B) showed a fistula (arrow head) extending from the esophagus to the fluid collection (*). Coronal view (C) of the CT scan following placement of an esophageal stent (arrow) showed good placement; axial view (D) showed occlusion of the fistula but severe compression of the trachea (arrow head). The fluid filled cavity is seen in both views (*). Coronal view (E) of the CT scan following palliative chemotherapy and nasogastric feeds showed persistence of the fistula and fluid filled cavity (*); axial view (F) showed persistence of the fistula (arrow head) and fluid filled cavity (*).
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Also seen was a fistulous tract extending from a thickened esophagus to the fluid collection (Figure 2A, B). Emergent chest CT scan was done revealing the stent to be in good position but causing severe tracheal compression (Figure 2C, D) requiring removal of the stent. A chest CT scan (Figure 2E, F) and esophagram performed 6 weeks later showed persistence of the fistulous tract.
Upper gastrointestinal series. An upper gastrointestinal series confirmed a fistulous tract (arrow) from the esophagus to the fluid filled cavity.
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An upper gastrointestinal series confirmed the fistula (Figure 3).
Upper endoscopy findings. At upper endoscopy a large fistulous opening (arrow head) was seen but could not be closed with endoclips.
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EGD, performed in an attempt to close the fistula, showed narrowing of the esophagus and opening to the fistula to be approximately 3 mm in diameter (Figure 4).