1 / 9

60 yof with recurrent pneumonia, regurgitation, and dysphagia

60 yof with recurrent pneumonia, regurgitation, and dysphagia. Luis Goity DR Elective. Clinical Data . 60 yof s/p CABG with hospital course c/b occlusion of grafts, respiratory failure requiring trach/peg, mucus plugging, and recurrent emesis and coughing

jacquese
Download Presentation

60 yof with recurrent pneumonia, regurgitation, and dysphagia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 60 yof with recurrent pneumonia, regurgitation, and dysphagia Luis Goity DR Elective

  2. Clinical Data • 60 yof s/p CABG with hospital course c/b occlusion of grafts, respiratory failure requiring trach/peg, mucus plugging, and recurrent emesis and coughing • Barium swallow performed to assess for mechanical/physical impediments to swallowing and possible aspiration

  3. Findings • Contrast material visualized passing from anterior wall of esophagus to trachea 1 cm below vocal cords • No laryngeal penetration of contrast into trachea above fistula • Scalloped filling defect of trachea at level of fistula, favored to be mass-like lesion

  4. Acquired Tracheo-Esophageal Fistula • Commonly caused by malignancy, iatrogenic damage • Infrequently caused by trauma, chronic esophagitis, TB, histoplasmosis • Best study to assess is endoscopy, VFSS is best imaging exam • CT can miss tract if it is collapsed – better assessment is CT with oral contrast • Benefit is added visualization of lung disease d/t fistula such as aspiration

  5. Risk Factors in This Patient • Prolonged hospitalization with intubation • High cuff pressures can lead to fistulization 2/2 tracheal mucosal necrosis • Poor nutrition • Secretions managed by suctioning with possible associated trauma • Tracheostomy with cuffed trach tube, tracheostomy instrumentation • However unlikely that trach cuff caused damage (fistula location higher than cuff location) • Diabetes

  6. Course for This Patient • ENT and pulm consulted, decided to allow TEF to heal with conservative measures • Mass in trachea at anterior ostium of fistula tract favored to be granulation tissue by ENT, which portends favorable prognosis and healing • Anti-emetics to avoid vomiting which can delay fistula closure • Optimization of nutrition

  7. Sources • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700431/ • https://radiopaedia.org/articles/acquired-tracheo-oesophageal-fistula-1 • https://www.ncbi.nlm.nih.gov/pmc/articles • https://radiopaedia.org/articles/barium-swallow

More Related