Hodgkin's disease presenting with a bronchoesophageal fistula

A Successful Treatment of Broncho-Esophageal Fistula with Esophageal Stenting Using Direct Endoscopic Visualization

Broncho-esophageal fistula (BEF) is a severe yet relatively rare connection between the bronchus and esophagus usually caused by esophageal and pulmonary malignancies. We present a case report of a 49-year-old man diagnosed with terminal lung carcinoma who developed a BEF. The thoracic computed tomography scan detected a mass in the left bronchi that partially covers and disrupts the bronchial contour in certain regions and extends to the esophageal wall. After thoroughly evaluating alternative treatment approaches, we opt for the stenting procedure due to the advanced stage of the tumor and the significantly diminished quality of life. The treatment involves the use of a partially covered metal stent that is known to exhibit lower potential to migrate. The treatment is highly successful, resulting in a significant enhancement of the patient's quality of life, a lengthening in his survival, and the ability to pursue additional palliative treatment options. In contrast to the typical prosthesis implantation, our procedure uses a direct endoscopic visualization for the proximal deployment of a partially covered stent, offering a cost-effective and radiation-free alternative that can be particularly beneficial for BEF patients in facilities without radiology services.

Bronchoesophageal fistula: An unusual manifestation of lung cancer

Bronchoesophageal fistula (BEF) is a rare condition caused by a fistulous connection between the bronchus and the esophagus. BEF can be acquired or congenital; congenital BEFs are rarely encountered in adults. Acquired BEF can be due to either a benign or a malignant process. Acquired BEF due to primary lung cancer is a life-threatening and usually a terminal complication. Unlike tracheoesophageal fistula, this condition is much rarer. Patients usually present with symptoms related to recurrent aspiration. Barium esophagogram is the initial diagnostic modality of choice. Treatment is primarily palliative. We are presenting a case of a bronchoesophageal fistula caused by non-small cell lung cancer that was successfully treated with concurrent chemoradiation therapy.

Gastropleural fistula masquerading as chylothorax in a child with lymphoma

We report the case of an 8-year-old boy with diffuse large B cell lymphoma who developed a right-sided spontaneous pneumothorax with pleural effusion after recovery from septic shock. The pleural fluid was thought to be malignancy-associated chylothorax concomitant with complicated pleural effusion due to a milky-like appearance, a high level of triglycerides and Gram-negative bacteria staining in the fluid. He was put on total parental nutrition and octreotide for 2 weeks, but did not improve. The laboratory results also showed a persistent bacterial infection in the pleural fluid despite appropriate antibiotics. Eventually, a CT scan revealed a fistulous tract between the right pleural cavity and the stomach. Fistula repair was successful by right open thoracotomy with decortication. Even though the gastropleural fistula is a very rare condition in paediatric patients, the physician should consider this diagnosis in a patient who has an unusual presentation or refractory chylothorax-like pleural effusion.

Lymphoma and tracheoesophageal fistula: Indication for a removable esophageal stent

Mediastinal lymphoma is a rare cause of tracheoesophageal fistula (TEF). While most reports described in the literature have been related to prior or concurrent chemoradiation therapy, TEF has rarely been reported as the initial presentation of lymphoma. We report on a young woman found to have Hodgkin's disease complicated by TEF that required emergent placement of an esophageal stent. The lymphoma was successfully treated and, due to stent-related symptoms, removal was desired but not technically possible. We discuss options that may prevent this predicament in the future.

[Bronchial erosion of mediastinal lymphadenopathy associates with Hodgkin's disease]

INTRODUCTION

Erosion of mediastinal adenopathy into the bronchial tree is classically associated with tuberculosis. We describe two cases of of such bronchial erosion with Hodgkin's disease.

CASE REPORT

The first case was of a seventy-year old man with a history of pulmonary silicosis. A sub-carenal mass was identified during investigation of chronic cough. The bronchoscopy revealed an inflammatory stenosis due to Hodgkin's disease. The second case was of a thirteen-year old child whose Hodgkin's disease was thought to be in remission following treatment. The erosion of mediastinal adenopathy into the main left bronchus produced complete left pulmonary atalectasis, which required endobronchial stenting.

CONCLUSIONS

In both cases, rigid bronchoscopy provided a histological diagnosis with diagnosis of Hodgkin's disease in the first case, and identification of recurrence in the other one. These cases are unusual. Such complications are usually complications of radiotherapy. Classically, erosion of mediastinal adenopathy into the bronchial tree is tuberculous in origin but they can be neoplasic.

Esophageal involvement as an uncommon modality of relapse of Hodgkin lymphoma

We present a case of systemic Hodgkin's lymphoma, relapsed with esophageal involvement after 3 years of complete remission. The importance of an accurate diagnostic work-up is emphasized. Esophagectomy and chemotherapy followed by bone marrow transplantation allowed a complete response and the long-term survival of the patient.