Case Report

Esophageal-Pleural Fistula: the Cause or Effect of Recurrent Pneumonia?

Abstract

Esophageal-pleural (E-P) fistula is introduced to be an uncommon clinical finding maybe due to non-specific clinical pointers and vague radiologic clues. In this regard, the main drivers are esophageal traumatization, endoscopic dilation, irradiation and corrosive agent ingestion as well as major underlying esophageal diseases like carcinomas and tuberculosis. The presented case is a 51-year-old man with medical record of recurrent pneumonias resulted in right lobectomy who admitted to the medical institution with a significant empyema leading to chest tube insertion. It should be noted that the presence of food particles in the chest bottle in addition to the history of previous surgery raised suspicion of a post-surgical E-P fistula formation. Attempts were made to find fistula tract and insert an esophageal stent bypassing the fistula opening. However, investigations argued against E-P fistula as an ensuing event after surgery and arose the question that whether E-P fistula would be the cause or effect of pneumonia in the presented case?

1. Shama DM, Odell JA. Esophagopleural fistula after pneumonectomy for inflammatory disease. J Thorac Cardiovasc Surg. 1985; 89: 77-81. https://doi.org/10.1016/ S0022-5223(19)38851-8
2. Van Den Bosch JMM, Swierenga J, Gelissen HJ, Laros CD. Postpneumonectomy oesophagopleural fistula. Thorax. 1980; 35: 865-8. https://doi.org/10.1136/thx.35.11.865
3. Benjamin I, Olsen AM, Ellis FH. Esophagopleural fistula. Ann Thorac Surg. 1969; 7:139-44. https://doi.org/10.1016/S0003- 4975(10)66159-0
4. Sethi GK, Takaro T. Esophagopleural fistula following pulmonary resection. Ann Thorac Surg. 1978; 25:74-81. https://doi. org/10.1016/S0003-4975(10)63492-3
5. Takara T, Walkup HE, Okano T: Esophagopleural fistula as a complication of thoracic surgery. J Thorac Cardiovasc Surg. 1960; 40: 179-93. https://doi.org/10.1016/S0022- 5223(19)32625-X
6. Vyas S, Prakash M, Kaman L, Bhardwaj N , Khandelwal N. Spontaneous esophageal-pleural fistula. Lung India. 2011; 28 (4): 300-2. https://doi.org/10.4103/0970-2113.85696
7. Long K, Dolina M. An Esophago-Pleural Fistula in a Case of Non-Resolving Pneumonia in a Patient with a History of Lung Cancer. Chest. 2016; 150 (45). https://doi.org/10.1016/j. chest.2016.08.843
8. Shan GD, Chen ZP, Xu YS, Liu XQ, Gao Y, Hu FL, et al. Gastric foreign body granuloma caused by an embedded fishbone: a case report. World J Gastroenterol. 2014; 20(12): 3388-90. https://doi.org/10.3748/wjg.v20.i12.3388
9. Cao L, Chen N, Chen Y, Zhang M, Guo Q, Chen Q, et al. foreign body embedded in the lower esophageal wall located by endoscopic ultrasonography: A case report. Medicine (Baltimore). 2018; 97(26):11275. https://doi.org/10.1097/ MD.0000000000011275
10. Pache G, Thuerl C, Bley T, Kotter E, Ghanem N. Asymptomatic esophagopleural fistula presenting 35 years after pneumonectomy for tuberculosis. J Thorac Imaging. 2005; 20:223-5. https://doi.org/10.1097/01. rti.0000155043.74533.79
11. Geng C, Li X, Luo R, Cai L, Lei X, Wang C. Endoscopic management of foreign bodies in the upper gastrointestinal tract: a retrospective study of 1294 cases. Scand J Gastroenterol. 2017;52(11):1286-91. https://doi.org/10.1080/00365521.201 7.1350284
12. Kamali A, Moudi E. Unusual presentation of an abdominal foreign body: A case report. Caspian J Intern Med. 2017; 8(2): 126-8. https://doi.org/10.22088/cjim.8.2.126
13. Mantzouranis E, Mathianaki K, Fitrolaki MD, Mihailidou E, Paspalaki P. A boy with recurrent pneumonia. Breathe. 2011; 8(1): 71-6. https://doi.org/10.1183/20734735.220710
14. Geppert EF. Chronic and recurrent pneumonia. Semin Respir Infect. 1992 Dec;7(4):282-8. pmid: 1307131
15. Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015; 3(13):183. https:// doi.org/10.3978/j.issn.2305-5839.2015.07.08
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IssueVol 7 No 5 (2022): September-October QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v7i5.11865
Keywords
Recurrent pneumonia Esophageal-pleural fistula Esophageal foreign body

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How to Cite
1.
Asadzadeh Aghdaei H, Sadeghi A, Nouri G, Salarieh N, Ketabi Moghadam P. Esophageal-Pleural Fistula: the Cause or Effect of Recurrent Pneumonia?. CRCP. 2023;7(5):242-245.