대한흉부영상의학회 Weekly Chest Cases

Case No : 1473 Date 2026-01-12

Courtesy of Geewon Lee / Pusan National University Hospital
Age/Sex 78 / M
Chief ComplaintChest pain; History of esophageal cancer

Figure 1
Figure 2
Figure 3
Figure 4

Diagnosis With Brief Discussion

Diagnosis: Esophago-pleural fistula
Radiologic Findings: Fig 1. Chest PA shows bilateral pleural effusion, bibasilar atelectasis and consolidation at the RLL field.
Fig 2-4. Postcontrast chest CT scans show communication between the esophagus and right pleural cavity.

Additional figure (Figure 5). Single-contrast esophagography shows a fistula tract connecting the esophagus and the right pleural space
Brief Review: Esophago-pleural fistula is a rare but serious condition that is often associated with severe infection and life-threatening morbidity. Esophago-pleural fistula may arise following pneumonectomy performed for suppurative or tuberculous disease, lung carcinoma, or as a complication of esophageal malignancy.
Patients typically present with signs and symptoms of empyema, including chest pain, high fever, and hypotension. The presence of additional symptoms such as dysphagia, odynophagia, or foul-tasting regurgitation should raise clinical suspicion for an esophago-pleural fistula.
Early-onset fistulas are usually caused by direct intraoperative injury to the esophagus, particularly when tumor is dissected from the esophageal wall, as in our patient. Indirect esophageal injury may also occur due to devascularization following mediastinal lymphadenectomy or excessive electrocautery. In contrast, late-onset fistulas are most commonly associated with tumor recurrence or chronic infection.
Although various endoscopic and surgical treatment strategies have been developed, esophago-pleural fistula-related mortality remains high. Therefore, early diagnosis and prompt management are crucial. Chest CT is a particularly valuable imaging modality for the early diagnosis and management of esophago-pleural fistulas.
References: 1. Dash M et al. Lung India 2017;34:287
Keywords

No. of Applicants : 98

▶ Correct Answer : 64/98, 65.3%

- Kyeongpook National University Hospital , Korea (South) JOHN BAEK
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- medical scanning , Japan HIROAKI ARAKAWA
- The University of Tokyo Hospital , Japan ISSEI FUKUDA
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Kyoto University , Japan AKIHIKO SAKATA
- Chonnam National University Hospital , Korea (South) CHAEWON SONG
- , Korea (South) KYUNG HYUN WOO
- Samsung Medical Center , Korea (South) HYUNGIN PARK
- Chonnam National University Hospital , Korea (South) HYUNJIN KIM
- , Italy PAOLO BALDASSARI
- , France CHARLES DAMIEN
- Yonsei University,Gangnam Severance Hospital , Korea (South) HONGGEUN CHO
- , Korea (South) DONG HEE LEE
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Kyeongpook National University Hospital , Korea (South) JUNGMIN LEE
- Other , Korea (South) HEE SEOK CHOI
- Other , Korea (South) SEONGSU KANG
- Kyung Hee University Medical Hospital , Korea (South) INKEON YEO
- Chonbuk National University Hospital , Korea (South) YONG HWAN JO
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- university of montreal , Canada Andrei Bogdan Gorgos I
- QATIF CENTRAL HOSPITAL , Saudi Arabia HANI M ALSALAM
- University of Yamanashi , Japan TAKAAKI HASHIMOTO
- University of Yamanashi , Japan HIROYUKI MORISAKA
- Chiba University Hospital , Japan HIROKI MIYAZAKI
- Asan Medical Center , Korea (South) HWAJIN LEE
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- , Japan YOSHIKI ISHII
- University of Yamanashi , Japan HIROAKI WATANABE
- Japanese Red Cross Otsu Hospital , Japan JUN YOSHIDA
- , Korea (South) MINSUN KOO
- Other , Korea (South) KI-NAM LEE
- Other , Korea (South) CHAEHUN LIM
- University Clinical Centre in Gdansk , Poland LUKASZ BUDYNKO
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Etlik City Hospital, Ankara , Turkey MERIC TUZUN
- , Korea (South) HEONSEOK LEE
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- , Chile PABLO VILLAFRANCA BROWN
- GHICL , France MANUEL TOLEDANO
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- Chonnam National University Hospital , Korea (South) SANGYONG BAK
- , Japan TOMOHIRO KAWAJI
- Chonnam National University Hospital , Korea (South) GYERYEONG PARK
- , Korea (South) JOOYEON KIM
- , Japan MATSUNO MAI
- Kyoto University , Japan SHO KOYASU
- Kobe Children , Japan SHUHEI NORIMOTO
- Seoul National University Bundang Hospital , Korea (South) YOONAH DO
- Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- , Sweden MOHAMAD TLASS
- Ehime University , Japan TOMOHISA OKADA
- Ehime University , Japan KOTARO MATSUMOTO
- Nara medical university , Japan HIROHIDE WATANABE
- University of Yamanashi , Japan KOJIRO ONOHARA
- Chonnam National University Hospital , Korea (South) JAEBONG YANG
- , Korea (South) SOONHO YOON
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 3/98, 3.1%

- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Seoul Medical Center , Korea (South) HYUK GI HONG

▶ Semi-Correct Answer : 1/98, 1.0%

- McGill University Health Center , Canada ALEXANDRE SEMIONOV

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1473 Date 2026-01-12

Discussion

No. of Applicants : 98