Читать книгу The Esophagus - Группа авторов - Страница 201

Esophageal–airway fistulae most commonly result from direct invasion of the tracheobronchial tree by advanced esophageal carcinoma (Figure 6.79). Such fistulae have been reported in 5–10% of all patients with esophageal cancer, often occurring after treatment with radiation therapy [140]. Other causes of esophageal‐airway fistulae include esophageal instrumentation, trauma, foreign bodies, and surgery. Affected individuals typically present with violent episodes of coughing and choking during deglutition. When an esophageal‐airway fistula is suspected on clinical grounds, barium should be used instead of water‐soluble contrast agents, because these hyperosmolar agents may cause severe pulmonary edema if a fistula is present [140].

Esophagopleural fistulae may be caused by esophageal carcinoma, radiation therapy, surgery, or instrumentation [140]. Such patients may present with a pleural effusion, pneumothorax, or hydropneumothorax. When an esophagopleural fistula is suspected, the presence and location of the fistula can be confirmed by a study with water‐soluble contrast agents.

Aortoesophageal fistulae are extremely rare but are associated with a high mortality rate. Such fistulae may be caused by a ruptured aortic aneurysm, aortic dissection, infected aortic graft, swallowed foreign body, or esophageal carcinoma [142]. Patients with aortoesophageal fistulae may present with an initial episode of arterial hematemesis followed by a variable latent period, before experiencing massive hematemesis, exsanguination, and death [142]. Oral studies with water‐soluble contrast agents are unlikely to show the fistula because of high aortic pressures, whereas contrast aortography may fail to show the fistula because of occlusion of the fistulous tract by thrombus [142].

Figure 6.79 Esophageal carcinoma with esophagobronchial fistula. A barium study shows an advanced infiltrating squamous cell carcinoma in the mid esophagus (straight arrows) with barium entering the airway via an esophagobronchial fistula (curved arrow).