CTICasesTuberculous Esophago-Lymph-Node Fistula
Imaging findings
CT in an HIV-positive patient demonstrates bulky mediastinal lymphadenopathy with air within the lymph nodes and silicone injection granulomas in the chest wall. Esophagogram confirms oral contrast opacifying the lymph nodes, demonstrating a fistulous tract from the esophagus into necrotic mediastinal lymph nodes. Endoscopy identified the esophageal fistula opening. Biopsy confirmed tuberculosis.
Key takeaways
Necrotic mediastinal lymph nodes from tuberculosis (or other granulomatous infections such as coccidioidomycosis) can erode into the esophagus, creating an esophago-lymph-node fistula, which is a rare but life-threatening complication. Air within mediastinal lymph nodes on CT should prompt concern for fistulous communication with either the esophagus or the tracheobronchial tree. Esophagography is the key diagnostic study.
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