title: Bronchial-oesophageal fistula: a rare initial presentation of squamous cell carcinoma of the lung.
abstract: A 61-year-old Caucasian man with hypertension and hepatitis C presented to the emergency department with 7 days of productive cough and low-grade fevers despite outpatient therapy with oral azithromycin. On initial evaluation, he was lethargic with peripheral cyanosis and oxygen saturation in the low 70 s on room air, necessitating endotracheal intubation. Chest imaging revealed diffuse bilateral infiltrates compatible with the diagnosis of acute respiratory distress syndrome. Patient subsequently developed profound hypoxaemia and on day 2 of admission, veno-veno extracorporeal membrane oxygenation (ECMO) was initiated. Bronchoscopy revealed a necrotic ulcer on the posterior wall of the left mainstem bronchus, compatible with a bronchial-oesophageal fistula, which was later confirmed by endoscopy, and stented. Histology revealed poorly differentiated squamous cell carcinoma of the lung. Despite stenting of the fistula and ECMO support, the patient expired 5 days after admission.
authors.affiliation: Department of Internal Medicine, Rutgers-NJMS, Newark, New Jersey, USA.
authors.forename: Narjust
authors.initials: N
authors.lastname: Duma
authors.affiliation: Saint Georges University, True Blue, Grenada.
authors.forename: Christian
authors.initials: C
authors.lastname: Barlow
authors.affiliation: Rutgers-NJMS, Newark, New Jersey, USA.
authors.forename: Larysa
authors.initials: L
authors.lastname: Sanchez
authors.affiliation: Hackensack University Medical Center, Hackensack, New Jersey, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Sadikot
mesh_terms: D001980:Bronchi / Q000473:pathology; D001983:Bronchial Fistula / Q000209:etiology*; D001999:Bronchoscopy; D002294:Carcinoma, Squamous Cell / Q000150:complications*; D004937:Esophageal Fistula / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy