Tuberc Respir Dis.  2008 Apr;64(4):303-308. 10.4046/trd.2008.64.4.303.

A Case of Bronchoesophageal Fistula Mimicking Pulmonary Tuberculosis

• Oh DW
• Ra SW
• Lee KH
• Park TS
• Kim SY
• Na SY
• Kim WD

• KMID: 1970182
• DOI: http://doi.org/10.4046/trd.2008.64.4.303

Abstract

Benign bronchoesophageal fistula is a rare disease and it may be characterized by nonspecific symptoms that can cause a delayed diagnosis. We misdiagnosed a patient with recurrent aspiration, which was due to bronchoesophageal fistula, as active pulmonary tuberculosis. The patient was 44 year old female who had suffered from chronic cough, especially during eating liquid meals, since 1982 when she had been treated for tuberculous lymphadenitis. Computed tomography showed an irregular mass with surrounding centrilobular nodules in the superior segment of the right lower lobe (RLL). She was diagnosed as having active pulmonary tuberculosis and treated with anti-tuberculosis medication, but she continued to complain of persistent cough even after anti-tuberculosis treatment. Thus, we reexamined the patient, and bronchoesophageal fistula between the esophagus and the superior segment of the RLL was finally confirmed by esophagography. After the fistula was surgically treated, the patient became asymptomatic and she then experienced good health.

Keyword

Chronic cough; Recurrent aspiration; Bronchoesophageal fistula; Tuberculosis; Tuberculous lymphadenitis; Fibrin Glue; Hemoclip

MeSH Terms

Cough
Delayed Diagnosis
Eating
Esophagus
Female
Fibrin Tissue Adhesive
Fistula
Humans
Meals
Rare Diseases
Tuberculosis
Tuberculosis, Lymph Node
Tuberculosis, Pulmonary
Fibrin Tissue Adhesive

Figure

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  Figure 1 Chest CT showed irregular mass with central calcification and surrounding centrilobular nodules and branching lesions in superior segment of right lower lobe.

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  Figure 2 Chest X-ray showed multiple calcified nodules and a bulging mass with calcification at right paratracheal area.

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  Figure 3 Chest CT showed cavitary lesion in superior segment of right lower lobe and fistulous tract (arrow) at right side of mid-esophagus.

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  Figure 4 Esophagography showed fistulous tract (arrow) between the esophagus and the superior segment of right lower lobe.

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  Figure 5 Bronchoscopy showed stenosis of the superior segmental bronchus of right lower lobe, but could not reveal the fistula orifice.

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  Figure 6 Esophagogastrofiberscopy showed the fistula orifice and both fibrin glue and hemoclip were used for closing fistula orifice.

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  Figure 7 Pathologic findings showed chronic active inflammation with abscess, cavity and dilated bronchioles (H&E stain, ×400).

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  Figure 8 Esophagography after fistulectomy operation showed no fistulous tract.

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