Answer for BIR CoW 23 Nov 2025
Broncho-esophageal fistula
Findings
Barium swallow (Iohexol contrast) shows narrowing of the cervical and thoracic esophagus with a metallic stent noted in situ. Opacification of bronchial tree and segmental airways noted after oral contrast administration. Evidence of pooling of contrast in the medial and basal segments of bilateral lower lobe. No evidence of esophageal mass. CT with oral dynamic shows fistulous communication between mid thoracic esophagus and bilateral lower lobe bronchus with patchy peri-bronchial consolidation. Impression: Narrowed cervical and thoracic esophagus with a fistulous communication between thoracic esophagus and bilateral lower lobe bronchi. Possibly malignant esophageal narrowing with a broncho-esophageal fistula.
Discussion
Follow up Oesophagogastroduodenoscopy Suspicious opening noted at 33cm in the esophagus and mesh was placed over the opening. Narrowed lumen of the entire length of esophagus. Biopsy HPE report done during OGD Moderately differentiated squamous cell carcinoma with no clear margins. Discussion- BEF can be a congenital/ acquired condition. Acquired causes can be due to trauma, endoscopic interventions, caustic ingestion, few infections like TB,candidiasis or mucormycosis. Esophageal cancer is the most common cause of BEF. C/F- coughing spells with oral intake ( Ono’s sign), recurrent pneumonia and unexplained weight loss. Initial diagnosis is by Barium esophagography. CECT with three dimensional reconstruction is gold standard. Treatment is by esophageal or bronchial stenting.
Findings
Barium swallow (Iohexol contrast) shows narrowing of the cervical and thoracic esophagus with a metallic stent noted in situ. Opacification of bronchial tree and segmental airways noted after oral contrast administration. Evidence of pooling of contrast in the medial and basal segments of bilateral lower lobe. No evidence of esophageal mass. CT with oral dynamic shows fistulous communication between mid thoracic esophagus and bilateral lower lobe bronchus with patchy peri-bronchial consolidation. Impression: Narrowed cervical and thoracic esophagus with a fistulous communication between thoracic esophagus and bilateral lower lobe bronchi. Possibly malignant esophageal narrowing with a broncho-esophageal fistula.
Discussion
Follow up Oesophagogastroduodenoscopy Suspicious opening noted at 33cm in the esophagus and mesh was placed over the opening. Narrowed lumen of the entire length of esophagus. Biopsy HPE report done during OGD Moderately differentiated squamous cell carcinoma with no clear margins. Discussion- BEF can be a congenital/ acquired condition. Acquired causes can be due to trauma, endoscopic interventions, caustic ingestion, few infections like TB,candidiasis or mucormycosis. Esophageal cancer is the most common cause of BEF. C/F- coughing spells with oral intake ( Ono’s sign), recurrent pneumonia and unexplained weight loss. Initial diagnosis is by Barium esophagography. CECT with three dimensional reconstruction is gold standard. Treatment is by esophageal or bronchial stenting.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!