CTICasesCuff-Induced Tracheoesophageal Fistula
Imaging findings
Chest CT in a ventilator-dependent patient demonstrates a massively over-inflated, cuffed tracheostomy tube that has caused erosion and tracheal wall disruption. A large focal defect (communication) is present between the posterior wall of the trachea and the anterior wall of the esophagus (tracheoesophageal fistula), associated with extensive mediastinal gas, mucosal thickening, and bronchial aspiration.
Key takeaways
Tracheoesophageal fistula is a severe, life-threatening complication of prolonged mechanical ventilation. It is caused by ischemic necrosis of the tracheal wall due to high cuff pressures exceeding capillary perfusion pressure, exacerbated by the presence of a rigid nasogastric tube in the esophagus. Prevention requires close monitoring of cuff pressures, and treatment requires surgical repair.
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