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Dong X, Pan R, Duan L, Lu X, Cao D. MSCT study for adult esophageal diverticulum with secondary broncho-esophageal fistula. J Cardiothorac Surg 2024; 19:107. [PMID: 38409055 PMCID: PMC10898017 DOI: 10.1186/s13019-024-02510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Broncho-esophageal fistula (BEF) secondary to esophageal diverticulum is a rare clinical condition, which is often misdiagnosed for a long time. The aim of our study is to summarize and clarify the advantages of MSCT in diagnosing BEF secondary to esophageal diverticulum. METHODS We retrospectively analyzed patients clinically diagnosed with BEF from January 2005 to January 2022 at Jilin University First Hospital. Only those patients with BEF secondary to esophageal diverticulum and complete clinical data met our enrolled standard. All patients' clinicopathologic characteristics and MSCT features were systemically evaluated. RESULTS 17 patients were eligible for our cohort study, including male 10 and female 7. The patient's mean age was 42.3 ± 12.5. The chronic cough occurred in all seventeen patients and bucking following oral fluid intake was documented in nine patients. MSCT distinctly suggested the fistulous tract between the bronchi and the esophagus in all patients. The mean diameter of the orifices in the wall of the esophagus was 4.40 ± 1.81 mm. The orifice in the midthoracic esophagus side was 15 cases and 2 cases at the lower thoracic esophagus. The involved bronchus included 13 cases at the right lower lobe bronchus, 1 at the right middle lobe bronchus and 3 at the left lower lobe bronchus. The contrast agent was observed in the pulmonary parenchyma in 10 of 13 patients who underwent esophagogram. No definite fistula was observed in 3 of 11 who underwent gastroscopy, while the intra-operative findings supported the existence of fistula. CONCLUSIONS BEF secondary to esophageal diverticulum tends to occur between the midthoracic esophagus and the right lower lobe bronchus. Compared with esophagography and gastroscopy, MSCT shows more comprehensive information about the fistulous shape, size, course and lung involvement, which are helpful for establishing diagnosis and guiding subsequent treatment.
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Affiliation(s)
- Xin Dong
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Ruonan Pan
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Lijun Duan
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Xiaoqian Lu
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Dianbo Cao
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China.
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Engel-Rodriguez A, Tiru-Vega M, Merced-Roman J, Fonseca-Ferrer V, Engel-Rodriguez N, Otero-Dominguez Y, Rodriguez-Cintron W. Diagnosis and Management of a Massive Eight-Centimeter Acquired Tracheoesophageal Fistula. Cureus 2023; 15:e43689. [PMID: 37724200 PMCID: PMC10505277 DOI: 10.7759/cureus.43689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Here, we present the case of a 61-year-old veteran Hispanic male with recurrent aspiration pneumonitis, aerophagia, tympanic abdominal bloating, and a positive Ono's sign; symptoms present were secondary to diagnosed tracheoesophageal fistulas (TEFs). TEFs are abnormal connections between the esophagus and the trachea. In adult cases, several risk factors have been identified for acquired cases, which include infection, trauma, and cancer. Diagnosis of TEF can be challenging and, in most cases, requires high suspicion. Currently, there are no established guidelines for diagnosing and managing TEF. Clinical assessment and various imaging techniques are essential in the diagnostic process. This article will discuss the etiology, clinical presentation, diagnostic approaches, and management options for acquired TEFs.
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Affiliation(s)
| | - Marilee Tiru-Vega
- Internal Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - Jesus Merced-Roman
- Internal Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - Vanessa Fonseca-Ferrer
- Pulmonology and Critical Care, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | | | - Yomayra Otero-Dominguez
- Pulmonary and Critical Care Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - William Rodriguez-Cintron
- Pulmonary and Critical Care Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
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Tubercular Bronchoesophageal Fistula in an Adolescent Girl. Indian J Pediatr 2022; 89:1107-1109. [PMID: 35226286 DOI: 10.1007/s12098-022-04116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/20/2022] [Indexed: 11/05/2022]
Abstract
Bronchoesophageal fistula is a rare complication of Mycobacterium tuberculosis in children. An adolescent girl who was diagnosed of tubercular mediastinal lymphadenopathy with associated bronchoesophageal fistula at presentation, is reported here. This 16-y-old girl presented with high-grade fever, cough, decreased appetite, weight loss for 3 mo, and breathlessness for 10 d. Chest radiograph revealed hilar lymphadenopathy with bilateral pleural effusion. GA GeneXpert was positive for mycobacterium and rifampicin sensitivity. Despite antitubercular therapy cough persisted and there was a history of dry cough with food intake, especially more on liquids. Bronchoscopy and CECT chest confirmed bronchoesophageal fistula in the right main bronchus just below the carina. Child continued on tube feeding and antitubercular therapy. After completion of intensive phase, child improved with resolution of clinical symptoms and scarring of tract on repeat bronchoscopy. It is concluded that in children with combination of mediastinal lymphadenopathy and persistent cough following intake of food needs careful evaluation for trachea/bronchoesophageal fistula.
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AlTarawneh S, Obeidat Y, Sherif A, Shweihat Y, Frandah W. A Complicated Parenchymal-Esophageal Fistula in Non-Small Cell Lung Cancer. Cureus 2022; 14:e22149. [PMID: 35308715 PMCID: PMC8920806 DOI: 10.7759/cureus.22149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/25/2022] Open
Abstract
Respiratory digestive fistula (RDF) is an abnormal communication between the airway and the digestive tract. Only 3-11% of RDF communications are parenchymal-esophageal fistulas. We present a case of a 58-year-old male who presented to the emergency department with dysphagia and cough after swallowing. He was diagnosed with stage III/B non-small cell lung cancer. The patient was previously treated with chemotherapy, radiation, and immunotherapy. Computed tomography (CT) scan of the chest with contrast showed a chronic cavitary right upper lobe lesion in the previously treated malignancy area. New right paratracheal adenopathy, right esophageal wall thickening, and bilateral lung infiltrates were also shown. Upper endoscopy with bronchoscopy and endobronchial ultrasound (EBUS) was done to evaluate mediastinal lymphadenopathy as well as dysphagia. A tract was found extending from the right lung cavity into the esophagus through the mediastinum. Esophagoscopy was subsequently performed, and a fistula was observed on the right wall of the mid-esophagus. The defect was favorable for clipping, which was successfully closed with an 11/6 traumatic over the scope clip, followed by a fully covered esophageal stent. The patient’s respiratory and gastrointestinal symptoms improved after the procedure. Follow-up barium swallow was negative for any esophageal leak. At three-month follow-up, the patient was free of recurrent pulmonary and gastrointestinal symptoms that he presented with. Palliative therapy is the targeted therapy for RDF management. RDF is either managed conservatively or with radiation, chemotherapy, or surgery to obliterate the connection. Surgical correction usually is not an option since patients typically have a poor functional status at the time of diagnosis. Considering the survival and recurrence rate medical intervention is the mainstay of treatment. Parallel dual (esophageal-bronchial) stenting has been proven to provide the best outcomes. Self-expanding metal stents (SEMS), either covered or partially covered, are used extensively to manage malignant RDF.
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Chuang J, Luke N, Patel K, Burlen J, Nawras A. Over-the-Scope Clip Closure of an Esophageal-Pleural Fistula Secondary to Esophageal Stent Placement: A Case Report. Cureus 2021; 13:e20696. [PMID: 35106233 PMCID: PMC8787100 DOI: 10.7759/cureus.20696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/13/2022] Open
Abstract
An esophageal fistula is a pathological connection between the esophagus and another structure. The most common treatment for an esophageal fistula is airway stenting. However, several case series have demonstrated the superiority of the over-the-scope clip (OTSC) system for fistula closure. We report a case requiring multiple stent/OTSC placements in an esophageal-pleural fistula (EPF) due to underlying malignancy. A 57-year-old male with stage IV esophageal cancer with an esophageal stent presented with three days of back pain and shortness of breath. A gastrografin was performed and showed a fistula at the proximal aspect of the pre-existing esophageal stent. A self-expandable metallic stent (SEMS) was utilized to bridge the fistula to the pre-existing esophageal stent. An esophagram two days later revealed extravasation and continuous esophageal leak. OTSC was then deployed at the fistula. A SEMS was also implanted through the patient’s pre-existing stent. Endoscopy showed persistent esophageal perforation. The initial OTSC and SEMS combination was removed. After removal, a second OTSC was placed over the fistula, allowing for complete suction of the fistula into the OTSC clip cap. We followed this by deploying another SEMS through the pre-existing stent and clipping them together. The proximal end of this new stent fully covered the fistula, creating a complete seal. This case is notable in that successful EPF closure secondary to existing esophageal stent erosion was achieved by utilizing a properly positioned OTSC with stent-within-stent combination management.
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Cuaño PMGM, Pilapil JCA, Larrazabal RJB, Villalobos RE. Acquired tracheoesophageal fistula in a pregnant patient with COVID-19 pneumonia on prolonged invasive ventilation. BMJ Case Rep 2021; 14:14/8/e244016. [PMID: 34417243 PMCID: PMC8381298 DOI: 10.1136/bcr-2021-244016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A previously healthy pregnant woman was diagnosed with COVID-19 pneumonia and was subsequently intubated. Throughout the course of her illness, the patient was treated for recurrent bouts of pneumonia. A high-resolution chest and neck CT scan confirmed the presence of a tracheoesophageal fistula (TEF), which may have been caused by the presence of the overinflated endotracheal cuff, prolonged steroid use, hypoxic injury and possible direct injury of the tracheal mucosa from COVID-19 itself. A temporising procedure, involving tracheostomy with an extended-length tracheal tube, was performed. Unfortunately, the patient succumbed to infection prior to definitive repair. This case highlights the importance of keeping a high index of suspicion for tracheal injury in patients who experience prolonged periods of intubation. It also underlies the high morbidity and mortality rate associated with TEF, although being a rare disease.
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Affiliation(s)
| | | | | | - Ralph Elvi Villalobos
- Division of Pulmonary Medicine, Department of Medicine, University of the Philippines Manila, Manila, Philippines
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Belle A, Lorut C, Lefebvre A, Ali EA, Hallit R, Leblanc S, Bordacahar B, Coriat R, Roche N, Chaussade S, Barret M. Amplatzer occluders for refractory esophago-respiratory fistulas: a case series. Endosc Int Open 2021; 9:E1350-E1354. [PMID: 34466358 PMCID: PMC8367450 DOI: 10.1055/a-1490-9001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.
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Affiliation(s)
- Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Lorut
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Lefebvre
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Department of Hepato-Gastroenterology, Ramsay Private Hospital Jean-Mermoz, Lyon, France
| | - Benoit Bordacahar
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Nicolas Roche
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
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Darwish B, Sikaria A, Kakaje A. A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria. Int J Surg Case Rep 2021; 84:106087. [PMID: 34146789 PMCID: PMC8220229 DOI: 10.1016/j.ijscr.2021.106087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Acquired tracheo-oesophageal fistula (TOF) is a rare complication of intubation or traumas, either blunt or penetrating. In a penetrating chest trauma, the closure of TOF can be challenging and requires a unique technique. A flap can and intra-tracheal tube can also be used. We present this case to demonstrate a unique late presentation of TOF and the unique approach that was used. Case presentation A patient presented with a large TOF caused by shrapnel, and was surgically managed after two months of the injury by using a smaller intra-tracheal tube, and using an oesophageal wall flap to close the tracheal defect and intercostal muscle flap was used for the oesophageal wall repair. The postoperative intrathoracic oesophageal leak was successfully treated conservatively. Clinical discussion Although the surgery could not be conducted until 2 months after the injury, the approach used was successful and the patient was able to resume his normal life after the surgery. The flap from the oesophagus and intercostal muscles and using a smaller tracheal tube successfully repaired the TOF with minimum stress on the suterings, and the conservative approach for the leak was also successful. Conclusion Traumatic TOF management can be complicated, but we speculate that using a smaller tube with the conservative management of the complications was ideal for the TOF acquired from a shrapnel. Acquired tracheo-oesophageal fistula (TOF) can be caused by trauma. The closure of TOF can be difficult and requires unique technique. Using a smaller intra- tracheal tube with a flap from oesophageal wall can help in TOF closure in the tracheas. Oesophagus wall injury from the shrapnel was managed by intercostal muscles. Post-operative oesophageal leak can be managed conservatively.
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Affiliation(s)
- Bassam Darwish
- Department of Thoracic Surgery, Al Mouwasat University Hospital, Damascus University, Damascus, Syria
| | - Amjad Sikaria
- Department of Thoracic Surgery, Al Mouwasat University Hospital, Damascus University, Damascus, Syria
| | - Ameer Kakaje
- Faculty of Medicine, Damascus University, Damascus, Syria; University Hospital Geelong, Barwon Health, Victoria, Australia.
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Yoo DH, Choi MS, Lee BJ, Shin YB, Yoon JA, Kim SH. Identification of acquired tracheoesophageal fistula after tracheostomy decannulation by videofluoroscopic swallowing study: A case report. Medicine (Baltimore) 2021; 100:e25349. [PMID: 33787636 PMCID: PMC8021360 DOI: 10.1097/md.0000000000025349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Videofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet. PATIENT CONCERNS A 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since. DIAGNOSIS VFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia. INTERVENTION VFSS was performed in this case. OUTCOMES In the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery. LESSONS This case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.
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Affiliation(s)
- Dong Ho Yoo
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Min Soo Choi
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jin A Yoon
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
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Goussard P, Andronikou S, Morrison J, van Wyk L, Mfingwana L, Janson JT. Management of children with tuberculous broncho-esophageal fistulae. Pediatr Pulmonol 2020; 55:1681-1689. [PMID: 32275811 DOI: 10.1002/ppul.24775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/31/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Broncho-esophageal fistula (BOF) is a rare complication of Mycobacterium tuberculosis (MTB). TB-associated BOF presents either as acute respiratory failure, aspiration pneumonia or as a complication of surgical decompression of thoracic lymph nodes. METHODS All children with TB- associated BOF were included. TB was diagnosed if MTB was cultured from respiratory secretions, Ziehl-Neelsen (ZN) smear was positive, GeneXpert MTB/RIF was positive or a chest radiograph revealed radiographic features typical of TB. BOF was diagnosed by a contrast swallow study and/or flexible bronchoscopy. Chest computed tomography (CT) scan was performed, if required. RESULTS Total of 20 children were diagnosed with TB-associated BOF between 1999 and 2019, with a 75% survival. A total of 85% BOF involved the left main bronchus. A total of 80% of patients were MTB culture or ZN smear-positive. Chest X-ray abnormalities included: extensive parenchymal disease (80%) and lymph gland enlargement (45%). CT features included visualization of the BOF (60%), esophageal air (73%) and pneumomediastinum (40%). BOF closure was achieved by surgical closure (46%), spontaneous closure (26%), fibrin glue (13%), and esophageal stent (13%). Multivariant regression analysis showed that C- reactive protein (CRP), albumin and CRP/albumin ratio were associated with mortality. CONCLUSION Most TB-associated BOF are left-sided. It presents either acutely, with respiratory failure, or with chronic respiratory symptoms of aspiration. Children requiring invasive ventilation have high mortality. Most TB-associated BOF requires surgical intervention, although the use of fibrin glue offers an attractive alternative option.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania
| | - Julie Morrison
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Lizelle van Wyk
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Lunga Mfingwana
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
| | - Jacques T Janson
- Department of Cardio-Thoracic Surgery, Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa
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Benmoussa A, Mechtoune M, Tissir R, Tazi I, Mahmal L. [œsotracheal fistula complicating primary mediastinal large B cell non-Hodgkin's lymphoma: a case study]. Pan Afr Med J 2019; 32:30. [PMID: 31143335 PMCID: PMC6522174 DOI: 10.11604/pamj.2019.32.30.17143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022] Open
Abstract
Le lymphome non hodgkinien médiastinal primitif (LNHMP) est un cancer rare, se complique exceptionnellement par des fistules trachéo-œsophagiennes reliant directement l'œsophage à la trachée, qui sont secondaires à l'atteinte tumorale œsophagienne ou à la chimiothérapie (l'intérêt de notre cas). Nous rapportons le cas d'une patiente de 24 ans, d'origine marocaine, suivie pour LNH médiatisnal primitif à grandes cellules B révélé par une dyspnée avec dysphagie et altération de l'état général. La patiente est mise sous chimiothérapie mais le tableau s'aggrave après la deuxième cure par l'apparition des infections pulmonaires à répétition avec notion de toux lors des repas responsable d'une impossibilité d'alimentation, le diagnostic de fistule trachéo-œsophagienne est retenu par fibroscopie œsogastroduodénale, mais l'évolution est marquée par le décès de la patiente malgré la mise en place de stent endoscopique et la bonne réponse à la chimiothérapie. La découverte précoce d'une fistule trachéo-œsophagienne chez le patient atteint de LNHMP est indispensable permettant la mise en route d'un traitement approprié.
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Affiliation(s)
| | | | - Rajaa Tissir
- Service d'Hématologie, CHU Mohammed VI Marrakech, Maroc
| | - Ilias Tazi
- Service d'Hématologie, CHU Mohammed VI Marrakech, Maroc
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Using a Sternocleidomastoid Muscle Flap to Close an Iatrogenic Tracheoesophageal Fistula in a Patient With Advanced Laryngeal Cancer: A Case Report and Literature Review. Ann Plast Surg 2018; 82:S126-S129. [PMID: 30516563 DOI: 10.1097/sap.0000000000001718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An iatrogenic tracheoesophageal (TE) fistula is one possible complication after total laryngectomy with flap reconstruction. We used sternocleidomastoid (SCM) rotation flap to close a TE fistula. METHODS AND RESULTS A 69-year-old man with laryngeal cancer underwent total laryngectomy with radial forearm free flap reconstruction. A tracheostoma stenosis was noticed 7 months after the tracheostomy tube was removed. The patient underwent tracheostoma dilatation; the iatrogenic TE fistula was noticed 1 month later. We used SCM rotation flap to close the TE fistula. The postoperative course was uneventful. A barium esophagogram showed no leakage in the esophagus. CONCLUSIONS Tracheoesophageal fistula can be reconstructed with an SCM rotation flap. If the TE fistula is of a suitable size, this reconstructive strategy is effective and simple to close persistent TE fistula and avoid further airway complications.
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Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM. Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:210. [PMID: 30023373 DOI: 10.21037/atm.2018.05.25] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Benign tracheoesophageal fistula (TEF) results from an abnormal communication between the posterior wall of the trachea or bronchi and the adjacent anterior wall of the esophagus. It can be acquired or congenital. The onset of the TEF has a negative impact on the patient's health status and quality of life because of swallowing difficulties, recurrent aspiration pneumonia, and severe weight loss. Several acquired conditions may cause TEF. The most frequent is prolonged orotracheal intubation (75% of the cases). Usually, there is an erosion of the tracheal and esophageal wall by the continuous pressure between the endotracheal tube and the esophageal wall; particularly in the presence of a nasogastric or feeding tube within the esophageal lumen. Furthermore, tracheal stenosis is often associated, and adds complexity to the disease. Preparation for the surgical procedure may take weeks or even months. It includes definitive weaning from mechanical ventilation, treatment of respiratory infection, physiotherapy, and correction of malnutrition through enteral feeding. Surgical repair of a TEF is an elective procedure. It consists of division of the fistula, suture of the esophagus and trachea and protection of the suture lines with a buttressed muscle flap. TEF repair is a complex and challenging procedure, thus, high morbidity and mortality are expected. Nonetheless, surgical management yields excellent long-term results, and it should be considered the first-line treatment for this condition. Definitive fistula closure occurs in about 90-95% of the cases.
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Affiliation(s)
- Benoit Jacques Bibas
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Manoel Pêgo-Fernandes
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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15
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Thawani R, Thomas A, Thakur K. Tracheomediastinal Fistula: Rare Complication of Treatment with Bevacizumab. Cureus 2018; 10:e2419. [PMID: 29872599 PMCID: PMC5985921 DOI: 10.7759/cureus.2419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tracheomediastinal fistula is a rare condition caused by multiple etiologies. We present a case of a patient of lung carcinoma receiving chemotherapy. A 63-year-old woman presented to the emergency room with a two-month history of worsening cough and shortness of breath. She was being treated with pemetrexed and bevacizumab for Stage IV non-small cell lung carcinoma. Chest X-ray showed a mass in the lung with mediastinal adenopathy. Computed tomography (CT) scan showed a perforation, confirmed with bronchoscopy. She had a secondary infection and she was started on intravenous antibiotics. The patient decided to continue care in a hospice. We present a rare complication of bevacizumab which has been only reported once in literature. Bevacizumab is known to cause tracheal fistulas when coupled with like invasive procedures. In our case, the patient developed a fistula without any invasive interventions. We advise that physicians using bevacizumab should be aware of the possibility of having such fistulas.
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Affiliation(s)
- Rajat Thawani
- Internal Medicine Resident, Maimonides Medical Center
| | - Anna Thomas
- Internal Medicine, Crozer-Chester Medical Center, Upland, USA
| | - Kshitij Thakur
- Internal Medicine, Crozer-Chester Medical Center, Upland, USA
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16
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Affiliation(s)
- Maoyin Pang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Omar Mousa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Monia Werlang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Timothy Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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17
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Green MS, J. Mathew J, J. Michos L, Green P, M. Aman M. Using Bronchoscopy to Detect Acquired Tracheoesophageal Fistula in Mechanically Ventilated Patients. Anesth Pain Med 2017; 7:e57801. [PMID: 29430408 PMCID: PMC5797673 DOI: 10.5812/aapm.57801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/14/2017] [Accepted: 06/06/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction An acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF. Angioedema of the airway is a rare but potentially devastating complication of angiotensin converting enzyme inhibitors (ACE-I) that could further add insult to the tracheal mucosa, predisposing to an acquired TEF. Case Presentation An elderly woman with multiple comorbidities and requiring mechanical ventilation, developed angioedema following intake of ACE inhibitor for hypertension. The ensuing airway edema made weaning off mechanical ventilation difficult. After repeated attempts at extubation, tracheostomy was performed. With the loss of airway after tracheostomy, the possibility of TEF was considered given her multiple risk factors and intra-operative findings of the tracheal mucosa. Conclusions While it may be difficult to predict who will actually develop a TEF, it is prudent to identify those at risk and take precautionary measures to prevent one. Emphasis should be placed on daily endotracheal cuff manometric pressure check to prevent ischemic changes of the tracheal mucosa resulting from high cuff pressures. Also, bronchoscopy could be used after extubating susceptible patients to detect an acquired TEF.
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Affiliation(s)
- Michael S. Green
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
- Corresponding author: Michael S. Green, DO, Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102. Tel: +01-2157627922, Fax: +01-2157628656, E-mail:
| | - Johann J. Mathew
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
| | - Lia J. Michos
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
| | - Parmis Green
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
| | - Mansoor M. Aman
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102
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18
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Are single or dual luminal covered expandable metallic stents suitable for esophageal squamous cell carcinoma with esophago-airway fistula? Surg Endosc 2016; 31:1148-1155. [DOI: 10.1007/s00464-016-5084-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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19
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Freire JP, Almeida JCMD. Review of (acquired) incidental, rare and difficult tracheoesophageal fistula management. World J Surg Proced 2014; 4:9-12. [DOI: 10.5412/wjsp.v4.i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/24/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Acquired benign tracheoesophageal fistula is a rare condition and a difficult problem. The rarity and unpredictable presentation of this condition makes the design and setting of randomized prospective trials impossible. Guidelines on this matter are also difficult to establish. Based on a comprehensive evaluation of published literature and their experience, the authors review the etiology and best options for treatment, either surgical and non surgical, according to present knowledge.
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20
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An unusual case of tracheoesophageal fistulae. Case Rep Med 2012; 2012:524687. [PMID: 22811726 PMCID: PMC3395297 DOI: 10.1155/2012/524687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 05/25/2012] [Indexed: 11/17/2022] Open
Abstract
Acquired tracheoesophageal fistulae (TEF) are commonly due to malignancy (M. F. Reed and D. J. Mathisen, 2003). We present the case of a patient with a deceptive history for TEF and report an approach that provides adequate oxygenation, ventilation, surgical exposure, and postoperative analgesia with excellent outcome.
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21
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Schlager A, Khalaileh A, Zamir G, Mintz Y, Jacob H, Rivkind AI. An endoscopic repair option for acquired esophagorespiratory fistulas. J Laparoendosc Adv Surg Tech A 2010; 20:465-8. [PMID: 20565303 DOI: 10.1089/lap.2010.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Benign acquired esophagorespiratory fistulas (BERFs) represent a broad spectrum of anatomic pathology presenting in a wide variety of clinical settings. These fistulas can lead to severe respiratory compromise and rarely close spontaneously. Surgical fistula closure has been the traditional therapeutic approach, but is associated with significant morbidity and mortality. The recent advent of endoscopic technologies suggests that minimally invasive procedures may offer a safe alternative to surgery for the treatment of esophagorespiratory fistulas. In this article, we present our experience in treating complex benign esophagorespiratory fistulas of diverse etiologies utilizing a primarily minimal invasive, endoscopic, or combined surgical and endoscopic approaches. Our experience demonstrates that an endoscopic-based approach is safe and technically feasible and can, potentially, spare a subset of patients from open surgery. A multidisciplinary decision-making process, based on individualized parameters, is a prerequisite for a successful outcome.
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Affiliation(s)
- Avraham Schlager
- Department of General Surgery, New York University Hospital, New York, New York 10016, USA.
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22
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Endoscopic Approach to Tracheoesophageal Fistulas in Adults. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2008. [DOI: 10.1016/j.tgie.2008.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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23
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Abstract
Endoscopic closure of gastrointestinal perforations, fistulas, and anastomotic dehiscence is technically feasible. Endoluminal closure of the instrumental perforations of the gastrointestinal tract can be accomplished immediately after the recognition of perforation, while avoiding the delay of arranging surgery and the trauma associated with thoracotomy or laparotomy. In addition, endoscopic closure should be considered in patients with anastomotic dehiscence and chronic fistulas as this may avoid the risk associated with reoperation. The outcome of closure depends on the technical expertise in the proper selection and use of various endoluminal closure options. Training of the endoscopists in the use of this novel technology will enhance the quality of care of our patients.
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Affiliation(s)
- G S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Internal Medicine, 4.106 McCullough Building, 301 University Boulevard, University of Texas Medical Branch, Galveston, TX 77555-0764, USA.
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24
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Goussard P, Sidler D, Kling S, Andronikou S, Rossouw GF, Gie RP. Esophageal stent improves ventilation in a child with a broncho-esophageal fistula caused by Mycobacterium tuberculosis. Pediatr Pulmonol 2007; 42:93-7. [PMID: 17133521 DOI: 10.1002/ppul.20532] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The deployment of an esophageal stent to aid in the ventilation of a child who had developed an acquired broncho-esophageal fistula caused by Mycobacterium tuberculosis (MTB) is described. The 12-month-old boy presented with respiratory failure requiring ventilation. The air leak via the fistula led to inadequate mechanical ventilation. The deployment of the stent resulted in successful ventilation, closure of the fistula, and eventual successful treatment.
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Affiliation(s)
- P Goussard
- Department of Pediatrics and Child Health, University of Stellenbosch and Tygerberg Children's Hospital, Cape Town, South Africa.
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26
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Raju GS, Thompson C, Zwischenberger JB. Emerging endoscopic options in the management of esophageal leaks (videos). Gastrointest Endosc 2005; 62:278-86. [PMID: 16046996 DOI: 10.1016/s0016-5107(05)01632-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Gottumukkala S Raju
- Division of Gasterology and Thoraic Surgery, Center for Endoscopic Research, Education, and Training (CERTAIN), University of Texas Medical Branch, Galveston, 77555, USA
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27
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Abstract
PURPOSE OF REVIEW This paper provides a review of the most recent literature regarding the use of endoluminal stents in the upper aerodigestive tract. RECENT FINDINGS New technologies and materials as well as modifications of traditional stents allows the palliation of patients with esophageal and tracheobronchial obstruction due to carcinoma, to obturate tracheoesophageal fistulas in patients who are poor surgical candidates and to provide temporary relief of aspiration while awaiting for definitive surgery. The use of stents for airway obstruction is limited by their tendency to migrate (silicone stents) or to produce abundant and airway threatening granulation tissue (self expandable metal stents). SUMMARY Stents are best used for the palliation of obstruction caused by tracheobronchial or esophageal malignancies and for those patients affected by benign conditions but who are considered poor surgical candidates.
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Affiliation(s)
- Ricardo L Carrau
- Department of Otolaryngology, University of Pittsburgh Medical Center, Eye & Ear Institute, Suite 500, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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