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A Curious Case of Recurrent Pneumonia

  • Emily R. Thomas
Published/Copyright: October 1, 2012
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 112 Issue 10

A 52-year-old woman presented to the emergency department in February 2012 with a productive cough of 2 months duration and recurrent pneumonia. The patient had a history of recurrent bacterial pneumonias and stage IIIC squamous cell esophageal cancer that was managed with chemotherapy and radiotherapy. Chest imaging (panel A) revealed a right lower lobe infiltrate consistent with a possible early pneumonia. Because of the large amount of expectoration, computed tomography was performed, results of which revealed a large tracheoesophageal fistula approximately 1 cm proximal to the carina (panel B). The patient was sent to a tertiary care facility for treatment and was lost to follow-up.

In adults, 50% of acquired tracheoesophageal fistulas manifest in the context of a mediastinal malignancy.1 Mediastinal malignancies, which have an incidence of 4.5% in US adults, are caused by esophageal cancer in 77% of cases.2 Tracheoesophageal fistula is considered an urgent oncologic complication.3 Physicians should therefore consider tracheoesophageal fistula in the differential diagnosis for pneumonia in patients with a history of mediastinal cancer, particularly esophageal cancer.

Address correspondence to Emily R. Thomas, DO, Assistant Professor, West Virginia School of Osteopathic Medicine, 400 N Lee St, Lewisburg, WV 24901-1128. E-mail:

  1. Financial Disclosures: None reported.

  2. Authors interested in contributing to “Clinical Images” should refer to the JAOA's “Information for Authors” at http://www.jaoa.org/misc/ifora.xhtml. Manuscripts should be submitted at http://mc04.manuscriptcentral.com/jaoa.

References

1 Diddee R Shaw IH . Acquired tracheo-oesophageal fistula in adults. Contin Educ Anaesth Crit Care Pain. 2006;6(3):105-108.10.1093/bjaceaccp/mkl019Search in Google Scholar

2 Burt M Diehl W Martini N et al. . Malignant esophagorespiratory fistula: management options and survival. Ann Thorac Surg.1991;52(6):1222-1228.10.1016/0003-4975(91)90005-BSearch in Google Scholar

3 Quint LF . Thoracic complications and emergencies in oncologic patients. Cancer Imaging. 2009;9(A):S75-S82.10.1102/1470-7330.2009.9031Search in Google Scholar PubMed PubMed Central

Received: 2012-03-23
Revised: 2012-05-29
Accepted: 2012-06-05
Published Online: 2012-10-01
Published in Print: 2012-10-01

© 2012 The American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2012.112.10.690
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. Letters
  2. Holding Rhetoric to a New Standard: What's the P Value of That Statement, Senator?
  3. Joining Forces: Military Perspectives for Osteopathic Medical Education
  4. Editorial
  5. Introducing the JAOA's New Online Manuscript Tracking System
  6. The Somatic Connection
  7. Self-Treatment of Myofascial Trigger Points Relieves Chronic Pelvic Pain
  8. Empirical Measurement of the Effects of Myofascial Release in Cervical and Lumbar Regions
  9. OMT and Obesity: A Timely Topic
  10. Myofascial Release Combined With Physical Therapy Improves Venous Blood Flow
  11. New Technology Sheds Light on CSF Flow Through the Brain
  12. Original Contributions
  13. C-Reactive Protein as a Predictor of Chorioamnionitis
  14. Research Funding at Colleges of Osteopathic Medicine in the United States
  15. The Role of Social Networking Web Sites in Influencing Residency Decisions
  16. Brief Report
  17. Combined Manual Therapy Techniques for the Treatment of Women With Infertility: A Case Series
  18. Case Report
  19. Carbon Monoxide Poisoning Secondary to Hookah Smoking
  20. Clinical Images
  21. A Curious Case of Recurrent Pneumonia
  22. In Your Words
  23. A Step Outside
  24. CME Quiz
  25. CME Quiz
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