Journal List > Tuberc Respir Dis > v.62(6) > 1001109

TOOLS
Park, Jang, Park, Song, Choi, Oak, Jung, and Kwon: A Case of Esophago-mediatinal Fistula Due to Esophageal Tuberculosis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 62(6): 531-535.

Published online: 30 June 2007

DOI: https://doi.org/10.4046/trd.2007.62.6.531

A Case of Esophago-mediatinal Fistula Due to Esophageal Tuberculosis

Eun Ho Park, M.D.1, Tae Won Jang, M.D.1, Mu In Park, M.D.1, Jun Young Song, M.D.1, In Su Choi, M.D.1, Chul Ho Oak, M.D.1, Maan Hong Jung, M.D.1, Jin Hwan Kwon, M.D.2

1Department of Internal Medicine, College of Medicine, Kosin University, Pusan, Korea.

2Department of Radiology, College of Medicine, Kosin University, Pusan, Korea.

Address for correspondence: Tae Won Jang, M.D. Department of Internal Medicine, Kosin University College of Medicine 34 Amnam-dong, Suh-gu, Pusan, 602-702, Korea. Phone: 82-51-990-6637, Fax: 82-51-248-5686, jangtw@ns.kosinmed.or.kr

Received 26 March 2007       Accepted 15 May 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

The esophagus is a rate site for rarely involved site of tuberculosis. The most common cause of esophageal tuberculosis is secondary involvement from adjacent tuberculous lymphadenitis. Esophago-nodal or esophagobronchial fistulas may be formed when tuberculous lymph nodes erode the adjacent esophageal or bronchial wall. We report a patient diagnosed with esophageal tuberculosis, which was complicated by an esophago-mediastinal fistula, by endoscopy, sputum acid fast bacilli (AFB) stain, chest computed tomography (CT), and an esophagogram. The patient was treated with antituberculous agents and chest CT and endoscopy showed that the fistula had closed completely.

Keywords: Tuberculosis, Esophagus-mediastinum

Figures and Tables

Figure 1
This radiographic study of chest shows multiple no-dular opacities in left upper zone. Perihilar engorgement is suspicious.
trd-62-531-g001
Figure 2
A 3 × 2 cm sized roundly deep ulce-rative lesion with fistular opening was noted at 33 cm site from upper incisor.
trd-62-531-g002
Figure 3
Esophagogram shows an irregular barium leakage outline the fistular in mid esophagus.
trd-62-531-g003
Figure 4
Contrast enhanced CT scan shows linear or oval gas collections in an enlarged left lower paratracheal lymph node. There is a communication between the esophagus and a mediastinal area of air attenuation and peripheral rim enhancement and calcified right lower lymph node.
trd-62-531-g004
Figure 5
Shallow ulceration at left lateral wall of mid esophagus. No evidence of mediastinal leakage.
trd-62-531-g005
Figure 6
A shallow well demarcated defect with tiny fistulous opening was noted. Much improving state comparing with previous study.
trd-62-531-g006
Figure 7
Follow up contrast enhanced CT scan show no abnormal air collection in mediastinum.
trd-62-531-g007

References

1. Im JG, Kim JH, Han MC, Kim CW. Computed tomography of esophagomediastinal fistula in tuberculous mediastinal lymphadenitis. J Comput Assist Tomogr. 1990. 14:89–92.
2. Williford ME, Thompson WM, Hamilton JD, Postlethwait RW. Esophageal tuberculosis: findings on barium swallow and computed tomography. Gastrointest Radiol. 1983. 8:119–122.
3. Devarbhavi HC, Alvares JF, Radhikadevi M. Esophageal tuberculosis associated with esophagotracheal or esophagomediastinal fistula: report of 10 cases. Gastrointest Endosc. 2003. 57:588–592.
4. Lockard LB. Esophageal tuberculosis: a critical review. Laryngoscope. 1913. 23:561–584.
5. Fahmy AR, Guindi R, Farid A. Tuberculosis of the oesophagus. Thorax. 1969. 24:254–256.
6. Gordon AH, Marshall JB. Esophageal tuberculosis: definitive diagnosis by endoscopy. Am J Gastroenterol. 1990. 85:174–177.
7. Im JG, Song KS, Kang HS, Park JH, Yeon KM, Han MC, et al. Mediastinal tuberculous lymphadenitis: CT manifestations. Radiology. 1987. 164:115–119.
8. Amorosa JK, Smith PR, Cohen JR, Ramsey C, Lyons HA. Tuberculous mediastinal lymphadenitis in the adult. Radiology. 1978. 126:365–368.
9. Catinella FP, Kittle CF. Tuberculous esophagitis with aortic aneurysm fistula. Ann Thorac Surg. 1988. 45:87–88.
10. Rubinstein BM, Pastrana T, Jacobson HG. Tuberculosis of the esophagus. Radiology. 1958. 70:401–403.
11. Jain S, Kumar N, Das DK, Jain SK. Esophageal tuberculosis. Endoscopic cytology as a diagnostic tool. Acta Cytol. 1999. 43:1085–1090.
12. Kochhar R, Sriram PV, Rajwanshi A, Gulati M, Kochhar S, Nagi B, et al. Transesophageal endoscopic fine-needle aspiration cytology in mediastinal tuberculosis. Gastrointest Endosc. 1999. 50:271–274.
13. Lyons WS, Seremetis MG, deGuzman VC, Peabody JW Jr. Ruptures and perforations of the esophagus: the case for conservative supportive management. Ann Thorac Surg. 1978. 25:346–350.
14. Lucaya J, Sole S, Badosa J, Manzanares R. Bronchial perforation and bronchoesophageal fistulas: tuberculous origin in children. AJR Am J Roentgenol. 1980. 135:525–528.
TOOLS
Similar articles