A leaking food pipe: Bronchoesophageal fistula secondary to lung cancer

Abstract

A 58-year-old female with advanced lung cancer, hypertension, hyperlipidemia, pulmonary artery thrombosis, bilateral subclavian artery stenosis, and vocal cord dysfunction presented to the ER with cough, shortness of breath, dysphagia, and weight loss. HR 114 bpm, RR 24/min, SpO2 95% on 4L, Temperature 36.2o C. She was lethargic, chronically ill-looking, and had bronchial breath sounds and crackles in the right upper lobe. Chest x-ray revealed enlarging previously known right upper lobe mass and loculated right pleural effusion. Contrast CT of the chest showed unchanged necrotic right apical mass, increased consolidation inferior to a mass in the right middle lobe, and metastatic infiltration of the right lateral 6th rib. She also had purulent secretions in all airways on bronchoscopy. Shortly after bronchoscopy, she had an episode of aspiration and required Intensive Care Unit (ICU) admission.