CTICasesEsophagopleural Fistula and Empyema from Esophageal Cancer
Imaging findings
A patient with esophageal cancer has a frontal radiograph showing a pleural fluid level with multiple air-fluid reflections and compressed lung; the lateral view shows a complex mediastinal abnormality. CT shows diffuse mediastinal fat infiltration by tumor with an irregular, contained perforation of the esophagus that communicates directly with an infected pleural space containing multiple gas bubbles, with hypertrophied extrapleural fat and a densely collapsed, angry-looking lung.
Key takeaways
A contained esophageal perforation from locally invasive esophageal cancer can fistulize into the pleural space and produce an empyema, and gas within an infected pleural collection adjacent to a known esophageal malignancy should prompt evaluation for an esophagopleural fistula rather than presumed simple parapneumonic empyema.
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