Esophagobronchial fistulae: Diagnosis by MDCT with oral contrast swallow examination of a benign and a malignant cause
A 65-year-old male presented with progressive dysphagia to solids over the past 2 months. An ultrasound of the neck revealed few enlarged lymph nodes which on fine needle aspiration (FNA) revealed neoplastic squamous cells. A plain and intravenous contrast-enhanced CT study with CT oral contrast swallow was performed. There was moderate irregular enhancing wall thickening of the upper and mid thoracic esophagus. There was a loss of fat plane between the esophagus and the carina, left mainstem bronchus, and aorta. A defect was seen in the posterior wall of the proximal left mainstem bronchus suggesting formation of a fistula with the esophagus []. A CT oral contrast swallow study performed in prone position with diluted non-ionic contrast (1:20 dilution of iohexol in normal saline) revealed a small fistula tract between the esophagus and the proximal left mainstem bronchus just distal to the carina []. Post-processing of this contrast swallow study with volume rendering depicted the fistulous communication in 3D [].