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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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2
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Khan A, Chakravarty A, Naqishbandi R, Qamar S. Atypical presentation of acquired tracheo-oesophageal fistula in an adolescent girl with pulmonary tuberculosis. BMJ Case Rep 2022; 15:15/2/e242384. [PMID: 35228211 PMCID: PMC8886356 DOI: 10.1136/bcr-2021-242384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a case of an adolescent girl presenting with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. Initial presentation during the ongoing COVID-19 pandemic was compatible with multisystem inflammatory response in children associated with COVID-19 (MIS-C). Subsequently a diagnosis of tuberculosis was made. During ventilation, she developed significant abdominal distension which was not relieved with nasogastric decompression. There was a high index of suspicion of bronchoenteric fistula. Bronchoscopy with adjunct oesophagoscopy demonstrated tracheo-oesophageal fistula (TEF). The classical presentation of TEF has been masked by onset of ARDS. During the pandemic the diagnosis of tuberculosis in high-burden countries decreased for multiple reasons leading to development of complications which are often confused with MIS-C. While diagnosing MIS-C, maintaining a high level of suspicion for concomitant or alternative aetiologies is essential.
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Affiliation(s)
- Afreen Khan
- Pediatrics, Hamdard Institute of Medical Science and Research, Delhi, Delhi, India
| | - Aparna Chakravarty
- Pediatrics, Hamdard Institute of Medical Science and Research, Delhi, Delhi, India
| | - Rizwan Naqishbandi
- Pediatrics, Hamdard Institute of Medical Science and Research, Delhi, Delhi, India
| | - Sumbul Qamar
- Pediatrics, Hamdard Institute of Medical Science and Research, Delhi, Delhi, India
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3
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Sasikumar C, Utpat K, Desai U, Joshi JM. "Esophagomediastinal fistula presenting as drug resistant tuberculosis". Indian J Tuberc 2019; 67:363-365. [PMID: 32825869 DOI: 10.1016/j.ijtb.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
Esophageal tuberculosis is one of the rarest forms of tuberculosis with higher incidence in immunocompromised cases. In majority of cases it is seen associated with esophagomediastinal and esophagotracheal fistulas. Diagnosis is established with the help of esophagoscopy followed by histopathology and microbiological analysis of biopsy sample. Treatment with antituberculous therapy alone is sufficient in majority of cases, however surgical management is mandatory in severe and non resolving cases. We thereby report an interesting case of esophagomediastinal fistula presenting as drug resistant tuberculosis with retroviral disease.
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Affiliation(s)
- Chinnu Sasikumar
- Department of Pulmonary Medicine, TNMC & BYL Nair Hospital, 2nd Floor, OPD Bldg, AL Nair Road, Mumbai Central, Mumbai, 400008, India
| | - Ketaki Utpat
- Department of Pulmonary Medicine, TNMC & BYL Nair Hospital, 2nd Floor, OPD Bldg, AL Nair Road, Mumbai Central, Mumbai, 400008, India
| | - Unnati Desai
- Department of Pulmonary Medicine, TNMC & BYL Nair Hospital, 2nd Floor, OPD Bldg, AL Nair Road, Mumbai Central, Mumbai, 400008, India
| | - Jyotsna M Joshi
- Department of Pulmonary Medicine, TNMC & BYL Nair Hospital, 2nd Floor, OPD Bldg, AL Nair Road, Mumbai Central, Mumbai, 400008, India.
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4
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Gastrointestinal CMV Disease and Tuberculosis in an AIDS Patient: Synergistic Interaction between Opportunistic Coinfections. Case Rep Med 2018; 2018:8047892. [PMID: 29991949 PMCID: PMC6016156 DOI: 10.1155/2018/8047892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/11/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
Abstract
The AIDS pandemic has made diseases such as tuberculosis, CMV disease, and other opportunistic infections more prevalent; these diseases may even be found to be associated among themselves, and the natural history of each disease may present in an unusual manner. We report the case of a 41-year-old man with HIV (CD4 of 144 cells/dL) and HCV with hematochezia due to tuberculosis in the ileocecal valve and descending colon and CMV tissue invasive disease in the esophagus and descending colon. Coinfection among tuberculosis and cytomegalovirus in the gastrointestinal tract was described only once in a patient with a recent diagnosis of HIV that affected the distal ileum and ascending colon. We will discuss the peculiarities of the case and the behavior of the immune system in the face of simultaneous opportunistic infections. This is a challenging scenario that has scarce publications and is of great clinical importance.
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Abstract
Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.
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Domb GH, Chole RA. The Diagnosis and Treatment of Scrofula (Mycobacterial Cervical Lymphadenitis). Otolaryngol Head Neck Surg 2016. [DOI: 10.1177/019459988008800404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mycobacterial cervical lymphadenitis, or scrofula, may be caused by Mycobacterium tuberculosis, or the atypical mycobacteria. It is important to distinguish between tuberculous cervical lymphadenitis and atypical mycobacterial cervical lymphadenitis, since medical and surgical treatment of each of these entities is different. The two types of scrofula are compared and contrasted. The appropriate treatment of each is discussed, and the complications of improper management are described.
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Affiliation(s)
- George H. Domb
- Department of Otorhinolaryngology, University of California, Davis Medical Center, Sacramento
| | - Richard A. Chole
- Department of Otorhinolaryngology, University of California, Davis Medical Center, Sacramento, California
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7
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Form and Function of Sleep Spindles across the Lifespan. Neural Plast 2016; 2016:6936381. [PMID: 27190654 PMCID: PMC4848449 DOI: 10.1155/2016/6936381] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/16/2016] [Indexed: 01/11/2023] Open
Abstract
Since the advent of EEG recordings, sleep spindles have been identified as hallmarks of non-REM sleep. Despite a broad general understanding of mechanisms of spindle generation gleaned from animal studies, the mechanisms underlying certain features of spindles in the human brain, such as “global” versus “local” spindles, are largely unknown. Neither the topography nor the morphology of sleep spindles remains constant throughout the lifespan. It is likely that changes in spindle phenomenology during development and aging are the result of dramatic changes in brain structure and function. Across various developmental windows, spindle activity is correlated with general cognitive aptitude, learning, and memory; however, these correlations vary in strength, and even direction, depending on age and metrics used. Understanding these differences across the lifespan should further clarify how these oscillations are generated and their function under a variety of circumstances. We discuss these issues, and their translational implications for human cognitive function. Because sleep spindles are similarly affected in disorders of neurodevelopment (such as schizophrenia) and during aging (such as neurodegenerative conditions), both types of disorders may benefit from therapies based on a better understanding of spindle function.
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8
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Pulmonary and mediastinal tuberculosis in an immunocompetent child presenting as sternal abscess protruding from the skin. Infection 2014; 43:255-6. [PMID: 25424029 DOI: 10.1007/s15010-014-0708-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
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Puri R, Khaliq A, Kumar M, Sud R, Vasdev N. Esophageal tuberculosis: role of endoscopic ultrasound in diagnosis. Dis Esophagus 2012; 25:102-6. [PMID: 21777339 DOI: 10.1111/j.1442-2050.2011.01223.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal involvement by tuberculosis is rare and is commonly secondary to mediastinal lymph nodal involvement. Endoscopic ultrasound (EUS) is a good modality for evaluation of both esophageal wall and mediastinal lymph nodes. The objectives were to study the role of EUS in diagnosing esophageal tuberculosis, to differentiate primary from secondary form, and to assess the response. Retrospective analysis of data over 7 years (i.e. from 2003 to 2009) was used. The study was set in a tertiary care referral institute and focused on patients diagnosed with esophageal tuberculosis. Interventions used included endoscopy, EUS, EUS-FNA (fine needle aspiration) followed by antituberculosis treatment. The main outcome measurements were symptoms, endoscopic features, EUS features, pathological yield, and response to treatment. There were 32 cases of esophageal tuberculosis. The primary symptom was dysphagia, and endoscopy showed ulcers in 18/32 (56.25%) and extrinsic bulge in 20/32 (62.5%) in middle one third of esophagus. EUS showed lymph nodes adjacent to esophageal pathology in all cases. Subcarinal region was the most common site of lymphadenopathy and they were matted, heterogeneous with predominantly hypoechoic center. Histopathology of endoscopic biopsy of ulcers and EUS-FNA of lymph nodes provided the diagnosis of tuberculosis in 27/32 (84.35%). All patients were treated with antitubercular treatment and showed good clinical, endoscopic and endosonographic response. This is a retrospective study, and PCR and culture for Mycobacterium tuberculosis were not done. Esophageal tuberculosis does not appear to be a primary disease and is most likely secondary to mediastinal nodal tuberculosis. A conglomerated mass of heterogeneous with predominantly hypoechoic lymph nodes with intervening hyperechoic strands and foci on EUS appears to be characteristic of mediastinal tuberculosis.
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Affiliation(s)
- R Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
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10
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Ferguson JH, Schwarz MI. A 53-year-old man with dysphagia, anorexia, and night sweats. Chest 2011; 138:1266-70. [PMID: 21051406 DOI: 10.1378/chest.10-1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- John H Ferguson
- Department of Pulmonary/Critical Care, University of Colorado-Denver, Campus Box C272, 1250 14th St, Denver, CO 80217, USA.
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11
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Park JH, Kim SU, Sohn JW, Chung IK, Jung MK, Jeon SW, Kim SK. Endoscopic findings and clinical features of esophageal tuberculosis. Scand J Gastroenterol 2010; 45:1269-72. [PMID: 20568972 DOI: 10.3109/00365521.2010.501524] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Mycobacterial involvement of the esophagus is rare. Similar abnormal lesions of the esophagus may be confused with esophageal cancer and deep fungal infections. We studied the clinical features, endoscopic findings, the role of histopathology, and the outcome of antituberculosis treatment in patients with esophageal tuberculosis. METHODS A single center based, retrospective study was performed. We reviewed the clinical and pathological records of patients with esophageal tuberculosis that were clinically diagnosed from 1997 to 2006. RESULTS Esophageal tuberculosis, confirmed by histology, was found in six patients. Five patients presented with local symptoms. The mean number of endoscopic sessions for a diagnosis was 1.8 sessions (range 1-3). For the histopathology, caseous necrosis was found in four patients but positive acid fast bacilli stains and tuberculosis-polymerase chain reaction were not detected. Patients diagnosed with esophageal tuberculosis tolerated medical therapy and responded well. CONCLUSION Because esophageal tuberculosis presents with various, diverse clinical features, and endoscopic findings, it is difficult to diagnose at one session of endoscopy. However, esophageal tuberculosis should be considered in the differential diagnosis if ulcerative lesions were found in the mid esophagus.
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Affiliation(s)
- Jae Hyung Park
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kyungpook National University Hospital, Daegu, Republic of Korea
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12
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Shah S, Fickling W, Apps M. Gastrointestinal tuberculosis: an unusual presentation. Clin Gastroenterol Hepatol 2007; 5:A28. [PMID: 17350893 DOI: 10.1016/j.cgh.2006.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Shameer Shah
- Queen Elizabeth, The Queen Mother Hospital, Margate, Kent, United Kingdom
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13
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Makanjuola D, al Orainy I, al Rashid R, Murshid K. Radiological evaluation of complications of intestinal tuberculosis. Eur J Radiol 1998; 26:261-8. [PMID: 9587753 DOI: 10.1016/s0720-048x(96)01091-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Complications of intestinal tuberculosis may be masked. This study aims to heighten awareness of these unusual clinical complications and the radiological findings in such cases. Over a period of 5 years, 21 patients with proven intestinal tuberculosis, 13 of whom presented with complications, are presented in this report. Radiological diagnosis was by barium gastrointestinal studies and computed tomographic (CT) evaluation. Surgical specimens and histopathology confirmed the diagnosis. The commonest complication was intestinal obstruction (N = 6). Others were esophagobronchial and duodenocolic fistulas (N = 2), significant gastrointestinal hemorrhage (N = 3) caused by ulcers in the small bowel and colon, and malabsorption syndrome (N = 3) caused by diffuse small bowel infiltration in 2 cases and duodenocolic fistula in the third case. None of the patients presented were immunocompromised. Though uncommon, tuberculosis should be considered in patients presenting clinically with intestinal obstruction, significant gastrointestinal hemorrhage and malabsorption state.
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Affiliation(s)
- D Makanjuola
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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14
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Abstract
BACKGROUND Tuberculous involvement of the esophagus has been extremely rare during the past 40 years. It will be, however, more frequently encountered in the future, as the number of immunocompromised patients is growing. This condition is usually secondary to infection in other thoracic sites, such as lungs, larynx, or mediastinum. The diagnosis is difficult if the suspicion of tuberculosis is not raised. Dysphagia and cough after ingestion of fluids and food are common symptoms without any other specific signs in these patients. Diagnosis is based on combination of esophagography, esophagoscopy, bronchoscopy, and computed tomographic scan. METHODS We present 3 patients with tuberculous fistulas of the esophagus. Two of our 3 patients were treated successfully with the combination of operation and antituberculous chemotherapy. Fistulas were resected and closed directly. Suture lines were secured with pedicled pleural flaps. RESULTS Both patients who underwent operation recovered without complications. One patient died without definitive diagnosis and treatment. CONCLUSIONS Treatment of tuberculous fistulas consists of operation and antituberculous chemotherapy, although antituberculous medication alone has been suggested to be effective if the diagnosis is early. However, operation is usually necessary to establish the correct diagnosis. Therefore, we believe that if the cause of the esophageal fistula cannot be verified, thoracotomy should be performed. If the fistula is left untreated the consequences are usually fatal.
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Affiliation(s)
- O J Rämö
- Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland
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15
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Fístula broncoesofágica y broncolitiasis. Arch Bronconeumol 1996. [DOI: 10.1016/s0300-2896(15)30794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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McAdams HP, Erasmus J, Winter JA. RADIOLOGIC MANIFESTATIONS OF PULMONARY TUBERCULOSIS. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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17
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Lee JH, Shin DH, Kang KW, Park SS, Lee DH. The medical treatment of a tuberculous tracheo-oesophageal fistula. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1992; 73:177-9. [PMID: 1421353 DOI: 10.1016/0962-8479(92)90154-c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tracheo-oesophageal (TE) fistulas caused by Mycobacterium tuberculosis are rare and usually require both surgical treatment and medical treatment with antituberculosis drugs. A patient with a tuberculous TE fistula and mediastinal lymphadenitis was successfully treated by medical management alone.
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Affiliation(s)
- J H Lee
- Division of Pulmonary Medicine, Hanyang University School of Medicine, Seoul, Korea
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18
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Abstract
Tuberculosis of the esophagus is rare. More cases of secondary tuberculosis of the esophagus have been reported compared to primary esophageal tuberculosis. An illustrative case of primary tuberculosis of the esophagus is presented and 54 published cases of esophageal involvement in tuberculosis are reviewed. There were eight primary and 46 secondary cases of esophageal tuberculosis. There were more male than female patients (M/F = 2.6:1) with an average age of 39.2 years (range 6 months to 75 years). Diagnosis can be difficult, being based on clinical, radiological, endoscopic, and histological features and on the response to chemotherapy. Most cases can be successfully treated with antituberculous chemotherapy even in the presence of fistulous tracts. Patients with esophageal tuberculosis in the presence of AIDS do not respond as well to antituberculous chemotherapy.
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Affiliation(s)
- J Eng
- Department of Thoracic Surgery, Bradford Royal Infirmary, England
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19
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Abstract
A 59-year-old man was seen with what preoperatively was thought to be an acquired esophagobronchial fistula secondary to an old burned-out infection with tuberculosis. At operation the gross and microscopic findings were most compatible with a congenital H-shaped esophagobronchial fistula. However, cultures of calcified lymph nodes grew Mycobacterium tuberculosis. The need for culturing calcified tissue to assure proper treatment is emphasized.
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Affiliation(s)
- G Raghu
- Department of Medicine, University of Washington School of Medicine, Seattle
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20
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Affiliation(s)
- P M Stoopack
- Department of Medicine, Kings County Hospital, New York
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21
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Affiliation(s)
- M T Rosario
- Department of Medicine, Harlem Hospital Center, College of Physicians and Surgeons, Columbia University, New York, New York
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22
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Yokoyama I, Ichihashi H, Kawahara K, Takada M, Kondo T. Esophago-pleuro-cutaneous fistula. A case report. THE JAPANESE JOURNAL OF SURGERY 1984; 14:139-42. [PMID: 6205202 DOI: 10.1007/bf02469805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In a sixty-three year old Japanese man with a history of long standing pulmonary tuberculosis, an unusual esophago-cutaneous fistula developed. The possibility of esophago-pleuro-cutaneous fistula was considered, because there was an old tuberculosis causing lung abscess of hilar lymph node adenopathy and which facilitated development of an extensive fistulous tract. The patient was effectively treated by palliative surgical procedure. This may be the first report of a benign esophago-pleuro-cutaneous fistula.
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Williford ME, Thompson WM, Hamilton JD, Postlethwait RW. Esophageal tuberculosis: findings on barium swallow and computed tomography. GASTROINTESTINAL RADIOLOGY 1983; 8:119-22. [PMID: 6852426 DOI: 10.1007/bf01948102] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Esophageal tuberculosis secondary to tuberculous mediastinal lymphadenopathy is a very unusual presentation of adult tuberculosis. We report a patient presenting with fever of unknown origin and dysphagia. Barium swallow demonstrated esophageal displacement, mucosal ulceration and perforation with a fistulous tract into the mediastinum. CT of the mediastinum gave the most complete delineation of the tuberculous mediastinal lymphadenopathy which surrounded and displaced the esophagus. The fistulous tract extending from the esophagus into the nodal mass was also seen on CT.
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24
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Senders CW, Babin RW. Management of benign fistulae between Zenker's diverticulum and the trachea. Ann Otol Rhinol Laryngol 1983; 92:349-52. [PMID: 6410967 DOI: 10.1177/000348948309200408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cases of acquired benign fistula of the respiratory tree and esophagus have been reported in relation to Mycobacterium tuberculosis and trauma. Fistula formation between the trachea and a Zenker's diverticulum is a similar type of condition in which nutritional and immunological deficiencies can rapidly result in further complications which may mimic a malignancy. Spontaneous fistula formation and vocal cord paralysis may result. Surgical management of this condition includes interposing viable muscle between the esophagus and trachea at the repair site.
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Abstract
Mediastinal lymphadenopathy is a prominent feature of adult tuberculosis in immigrant groups in the United Kingdom. Chest radiography of 95 tuberculous immigrants showed mediastinal gland enlargement in 29 cases, whereas none of the 42 Europeans showed this feature. An analysis has been made of the distribution of the disease in all groups together with a more detailed evaluation of mediastinal involvement in the immigrants. Pericardial effusions were seen in eight patients together with the following three unusual complications: (1) broncho-oesophageal fistula; (2) bronchial erosion; (3) superior mediastinal obstruction.
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Abstract
In a twenty-year period we have seen 7 patients with acquired nonmalignant bronchoesophageal fistulas at the Vanderbilt University Affiliated Hospitals. There were 5 men and 2 women ranging from 24 to 82 years old. Six patients were seen initially with a history of pulmonary inflammatory disease with cough and fever or with an abnormal chest roentgenogram. One patient had a traumatic fistula following blunt chest trauma. Six of the patients were treated surgically with no operative mortality. Five were repaired through a right-sided thoracotomy with division of the fistulous tract and closure of the bronchus and esophagus. One patient required esophageal resection and later reconstruction for permanent fistula closure. The remaining patient was diagnosed at bronchoscopy and was not treated surgically because of supervening complications following an extensive abdominal operation. Once the diagnosis was established, operative management resulted in complete closure of the fistulas, with no mortality and no late recurrences in these patients.
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