Pyopneumothorax as a presentation of spontaneous esophagopleural fistula due to esophageal cancer: a case report
MM. Inayati*a (Mrs), W. Aniwidyaningsiha (Dr), M. Elhidsia (Dr), H. Hidajatb (Dr)
a Universitas Indonesia - Persahabatan Hospital, Jakarta, INDONESIA ; b Persahabatan Hospital, Jakarta, INDONESIA
Background: Esophagopleural fistula (EPF) is a rare medical condition that can be caused by malignancy, trauma, or complication postpneumonectomy. It is associated with high morbidity and high mortality due to empyema and nutritional deficiency. In patients with esophageal cancer, the incidence of EPF formation is 4,9%. Bronchoscopy, pleuroscopy, and esophagoscopy are essential to establish the diagnosis of EPF.
Case report: We present a case of a 47-years-old male patient with sudden onset of breathlessness and dysphagia following an open cholesistectomy procedure, without history of trauma. His chest radiograph and CT-scan showed right hydropneumothorax with esophageal dilation, and the pleural fluid production was exudative, consistent with empyema. However, the fluid consisted of food debris, hence our suspicion of EPF. Bronchoschopy showed compression to the right intermediate bronchus. Pleuroscopy showed chronic thickening of the right parietal pleura, confirmed by histopathology as a chronic granulomatous inflammation. Esophagoscopy confirmed a tumor along the patient’s esophageal wall, a non-keratinized squamous cell carcinoma that could easily ruptured and cause a fistula to the pleural cavity. The patient’s comorbidities include tuberculosis, severe sepsis, and malnutrition, causing his condition to worsen in a month after being admitted to the hospital.
Conclusion: The formation of EPF is an uncommon condition and it has no specific clinical condition. If the pleural fluid is suspected to have generated from the digestive system, we should perform comprehensive diagnostic steps, starting with chest CT-scan and esophagogram to diagnostic procedures such as bronchoscopy, pleuroscopy, and esophagoscopy. The definitive therapy should be surgery, but in some cases, the patient’s condition could worsen due to secondary infection or severe malnutrition.
Disclosure of funding source(s): none