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Clinical Images  |   October 2012
A Curious Case of Recurrent Pneumonia
Author Notes
  • Address correspondence to Emily R. Thomas, DO, Assistant Professor, West Virginia School of Osteopathic Medicine, 400 N Lee St, Lewisburg, WV 24901-1128. E-mail: ethomas@osteo.wvsom.edu  
Article Information
Imaging / Pulmonary Disorders / Clinical Images
Clinical Images   |   October 2012
A Curious Case of Recurrent Pneumonia
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 690. doi:10.7556/jaoa.2012.112.10.690
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 690. doi:10.7556/jaoa.2012.112.10.690
A 52-year-old woman presented to the emergency department in February 2012 with a productive cough of 2 months duration and recurrent pneumonia. The patient had a history of recurrent bacterial pneumonias and stage IIIC squamous cell esophageal cancer that was managed with chemotherapy and radiotherapy. Chest imaging (panel A) revealed a right lower lobe infiltrate consistent with a possible early pneumonia. Because of the large amount of expectoration, computed tomography was performed, results of which revealed a large tracheoesophageal fistula approximately 1 cm proximal to the carina (panel B). The patient was sent to a tertiary care facility for treatment and was lost to follow-up. 
In adults, 50% of acquired tracheoesophageal fistulas manifest in the context of a mediastinal malignancy.1 Mediastinal malignancies, which have an incidence of 4.5% in US adults, are caused by esophageal cancer in 77% of cases.2 Tracheoesophageal fistula is considered an urgent oncologic complication.3 Physicians should therefore consider tracheoesophageal fistula in the differential diagnosis for pneumonia in patients with a history of mediastinal cancer, particularly esophageal cancer. 
   Financial Disclosures: None reported.
 
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References
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