Iatrogenic Tracheoesophageal Fistula

      A 60-year-old woman presented with difficulty in breathing due to tracheal compression from limited stage small cell lung cancer (Fig. 1A). A prophylactic Niti-S stent (Taewoong Medical, Seoul, Korea) was deployed in the distal trachea before chemoradiotherapy. She then completed six cycles of carboplatin/etoposide chemotherapy over 5 months and mediastinal radiotherapy to a dose of 40 Gy in 15 fractions over 3 weeks. Three months after completion of her chemoradiotherapy, she developed irritating persistent cough. Computed tomography examination demonstrated a large tracheoesophageal fistula at the distal end of the stent (Fig. 1B) with bilateral consolidation due to aspiration. The fistula was bypassed by a 20/30 mm carinal Y Nitinol stent (Micro-Tech Europe, Nanjing, China; Fig. 1C) across the carina but the patient died due to worsening of acute respiratory distress syndrome. Iatrogenic tracheoesophageal fistula can be a fatal complication of endobnting, especially in patients having chemoradiotherapy.
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      FIGURE 1A, Transaxial CT image showing extensive mediastinal soft tissue mass causing severe tracheal compression (black arrow). B, Sagittal CT image reconstruction elegantly demonstrates the tracheoesophageal fistula (white arrow) and tracheal stent (arrowhead). C, Coronal CT image depicts the “Y” stent (arrow) and parenchymal changes in right upper lobe secondary to aspiration (arrowhead).