A Rare Benign Bronchoesophageal Fistula Presenting in Adulthood: A Case Report

Abstract

We report a rare case of benign bronchoesophageal fistula (BEF) of the main left lung lower lobe bronchus associated with granulomatous disease. A 30-year-old male was repeatedly seen over a period of three years at our institution for vague abdominal and respiratory symptoms. He underwent chest radiograph, CT scan of the neck, modified barium swallow study, and multiple endoscopies and laryngoscopies without a definitive diagnosis. A diagnosis of bronchoesophageal fistula was made by single contrast esophagram when a fistulous tract was demonstrated between the esophagus and left lower lobe bronchus. Chest computed tomography scanning demonstrated the fistulous tract, but also showed multiple calcified mediastinal lymph nodes adjacent to the site of fistula, which were thought to be consistent with prior granulomatous disease, likely histoplasmosis which is endemic to our area. The patient was treated surgically, and the fistula, adhesions, and adherent calcified lymph node were all removed at the time of the procedure. The presence of histoplasmosis could not be confirmed, but is most likely the cause of this uncommon BEF presentation. In conclusion, this is a rare presentation of a benign, acquired broncho-esophageal fistula associated with fungal infection. doi:10.4021/jmc138w