대한흉부영상의학회 Weekly Chest Cases

Case No : 751 Date 2012-03-19

Courtesy of Kyung Won Doo, Hwan-Seok Yong, Eun-Young Kang / Korea University Guro Hospital
Age/Sex 46 / M
Chief Complainthemoptysis, 1month productive cough, 8months

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Figure 1

Diagnosis With Brief Discussion

Diagnosis: Broncho-esophageal fistula with actinomycosis
Radiologic Findings: Chest CT shows cavitary lesion with irregular thick wall, central fluid densities and focal high density at cavity wall in RLL superior segment. A tubular low density extended from esophageal lumen to RLL near the cavitary lesion was found. Diffuse centrilobular nodules with branching densities in RLL and surrounding GGO were noted around cavity.
After medical treatment with antibiotics, RLL lobectomy was performed. The connection between the esophagus and basal segmental bronchus of RLL was confirmed during the operation. The histopathological diagnosis revealed that chronic inflammation with sulfur granules, consistent with actinomycosis.
Brief Review: Tracheobronchoesophageal fistulas that present in adulthood are usually due to malignancy or iatrogenic. There are several non-malignant causes of rare tracheobronchoesophageal fistula that present in adults. Common non-malignant causes include: foreign body ingestion, trauma, and iatrogenic injuries. Compared to tracheo-esophageal fistulas, which has pronounced symptoms, benign BEF presents with rather inconspicuous and insidious symptoms such as chronic cough or asthma not responding to treatment. Those nonspecific symptoms may delay a correct diagnosis. The symptom of BEF presented with repeated and persistent respiratory infections which can lead to the development of bronchiectasis, coughing when eating, and hemoptysis.
CT is a noninvasive study that can be useful in detecting unsuspected adult tracheobronchoesophageal fistulas. This is critical since early diagnosis and treatment can prevent longterm sequelae such as dysphagia, recurrent pneumonia, obstructive and restrictive ventilatory defects, and airway hyper-reactivity. Sometimes, despite thorough investigation, the diagnosis is made only at surgery. Once diagnosed, benign BEFs require immediate surgical treatment because of the risk of chronic sepsis, wider tissue destruction requiring additional surgery or fatal massive hemoptysis.
References: 1. Mangi AA, Gaissert HA, Wright CD, et al. Benign broncho-esophageal fistula in the adult. Ann Thoracic Surg 2002; 73; 911
2. Chaky DM, Escamilla C, Sheridan PH, Deboer D. Adult Bronchoesophageal Fistula Diagnosed on Computed Tomography. Radiology Case Reports. 2008;3:126.
Keywords: bronchus, esophagus, infection, bacterial,

No. of Applicants : 120

▶ Correct Answer : 68/120, 56.7%

- , Korea (South) park ji hoon
- Sunchun university hospital, Bucheon , Korea (South) So Young Bae
- HIA Legouest - METZ , France Alban Gervaise
- NDMVP Nashik , India Imran Jindani
- Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
- Kyung Hee University Medical center , Korea (South) Myung-Won
- Korea university , Korea (South) Kun Woo Kang
- Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
- Hangang sacred heart hospital , Korea (South) You Mie Han
- Hanam sungshim hospital , Korea (South) CHANG IL KIM
- SNUH , Korea (South) Euijin Hwang
- KOREA UNIVERSITY ANSAN HOSPITAL , Korea (South) in choi
- Seoul Soonchunhyang Univ Hospital , Korea (South) Seoyoun Choi
- Das Allgemeine Krankenhaus Celle , Germany Davis Chiramel
- Hopital Louis Pradel LYON , France matthieu ROUSSET
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Suncheon Plus Medicine , Korea (South) Park Sang Hyun
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- AMCH , India hage tadu
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- KING ABDULAZIZ SPECIALIST HOSPITAL , Saudi Arabia Elbagir Nasser
- CHU Poitiers , France CHAN paul
- Seoul National University Hospital , Korea (South) YongSub Song
- Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
- Chonnam national university hospital , Korea (South) SeungJin Lee
- XiangYa hospital , China Xia Yu
- fmmc , India subas kandimalla
- China Medical University ,Taiwan,R.O.C. , Taiwan Jun JunYeh
- Saga University , Japan Ryoko Egashira
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Kangdong Kyunghee university medical center , Korea (South) Soyoun Shin
- Asan Medical Center , Korea (South) Sang Min Lee
- Asan Medical Center , Korea (South) Hye Jeon Hwang
- Asan medical center , Korea (South) Hyun Joo Lee
- Montreal , Canada Drago Le King
- Asan Medical Center , Korea (South) Ji Eun Kim
- Asan Medical Center , Korea (South) Eunyoung Kim
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Hanyang University Hospital , Korea (South) Yo Won Choi
- Chungnam National University hospital , Korea (South) sunkyoung you
- Dong san medical center , Korea (South) Young Eun Bahn
- o2 clinic, pudukottai, india , India siva raja
- Universidad del Desarrollo , Chile Patricio Maximiliano Latorre Brajovic
- KyungHee University Hospital at Gangdong , Korea (South) Ka Eun Lee
- Hanyang university medical center , Korea (South) YOONAH SONG
- Vitalife Clinics , Pune , India. , India Rahul Deshmukh
- IRSA La Rochelle France , France Denis Chabassiere
- Chungbuk National University Hospital , Korea (South) Su Jeong Hyun
- Chungbuk univertisy hospital , Korea (South) Soohyun Lee
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Radnet Teleradiology Istanbul , Turkey Armagan Sarac
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- IRSA , France, Metropolitan BIGOT
- Alswaida- zaid alsherity hospital , Syria jehad alakabani
- A.P.Chest hospital ,hyderabad , India bhaskar kakarla
- Saint Malo , France jean-baptiste Noel
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Hopital du Sacre Coeur , Canada Andrea Ojanguren
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- Okayama university , Japan Mayu Uka
- Chuncheon Sacred Heart Hospital , Korea (South) Kyung bum Nam
- CHU Poitiers , France Thomas Rocher
- Asan medical center , Korea (South) Sang Young Oh
- KUMC ansan , Korea (South) kihwan kim
- National Taiwan University Hospital , Taiwan Li-Ta Keng

▶ Correct Answer as Differential Diagnosis : 15/120, 12.5%

- radiologist, aditya imaging centre , India vivek patel
- Travancore Medical College , India Chary D
- All India Institute of medical sciences , India Justin Moses
- Kurashiki Seijin-byo Center , Japan Akihiro Tada
- Goa Medical College , India Paresh Desai
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- All India Institute of Medical Sciences , India Jitesh Ahuja
- Inha Univ. hospital , Korea (South) JONGBUM KIM
- stanley medical college & GHTM , India madhan k
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- Seoul St Mary Hospital , Korea (South) Chae Lim
- Kohka Public Hospital , Japan Akitoshi Inoue
- CHRU Lille , France Paul Lebert
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- chp st martin , France Mariotte benoit

▶ Semi-Correct Answer : 4/120, 3.3%

- Onomichi municipal hospital , Japan Hirofumi Mifune
- Paramount Diagnostic & Research Centre , India Mahavir Swami
- Scans world , India Philson Mukkada
- Private Clinic , Brazil Lenine Cunha

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 751 Date 2012-03-19

Discussion

No. of Applicants : 120