CTICasesEsophagopleural Fistula from Metastatic Adrenocortical Carcinoma
Imaging findings
CT chest in a patient with metastatic adrenocortical carcinoma shows new gas collections within a large subcarinal metastatic lymph node mass. The gas communicates directly with the esophageal lumen and the right pleural cavity, which contains a large, complex pleural effusion.
Key takeaways
Mediastinal metastases or primary tumors can undergo necrosis and erode adjacent structures. Erosion of a subcarinal mass into the esophagus and pleural space forms an esophagopleural fistula, leading to direct passage of air and esophageal contents into the pleural space, resulting in empyema.
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