CTICasesGastrobronchial Fistula
Imaging findings
An outside radiograph from 2015 shows what appears to be a necrotizing left lower lobe pneumonia with an area of necrosis surrounded by consolidation. The patient had a history of gastric bypass, complicated by a left upper quadrant abscess with breakdown of staples and a fluid collection extending outside the excluded stomach. A more recent study shows an enlarging area of consolidation in the left lower lobe, and a tract of air extending directly from the intra-abdominal abscess towards this area, connecting completely into the lung parenchymal process, clearly shown on coronal views.
Key takeaways
Whenever persistent or enlarging abnormalities are present in the lower lobes abutting the diaphragm, it is crucial to examine the other side of the diaphragm for communication. Prior surgery and complications, such as an intra-abdominal abscess, can lead to complex fistulas like a gastrobronchial fistula, mimicking primary lung infections or malignancies.
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