CTICasesRuptured Esophageal Squamous Cell Carcinoma with Bronchoesophageal Fistula, Pneumothorax, and Empyema
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Imaging findings
Initial chest radiographs show a hiatal hernia and anterior consolidation. Follow-up shows worsening consolidation, a pleural effusion, and a new right pneumothorax. CT reveals a pneumothorax with debris in the pleural space, a bizarre mediastinal collection, and consolidated lung with debris and narrowing in the bronchus intermedius. Upper GI demonstrates esophageal irregularity, extravasation of contrast into a large leak, and communication with the chest tube.
Key takeaways
Spontaneous pneumothorax, empyema, and an aspiration picture in a patient with a mediastinal mass and hiatal hernia should raise suspicion for an esophageal rupture or fistula, possibly due to underlying malignancy. The presence of oral/GI tract organisms in pleural cultures supports this.
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