Esophageal squamous cell carcinoma with pleuropulmonary fistula
Presentation
Chronic dysphagia and recent respiratory symptoms.
Patient Data
There is circumferential, irregular and asymmetric increase in mural thickness (up to 16.0 mm in maximum size, unilaterally on the posterior aspect) of the thoracic esophagus from D6 up to D10/11 level (about 9.4 cm total length of the involved segment) with significant surrounding fat stranding. A large, thick-walled, ill-defined, cavity formation is seen in the left lobe (encasing the adjacent aorta) with its connection with the involved segment of the esophagus (opposite to D7/8 level) suggestive of esophagopleural fistula.
Ground glass haze with tree-in-bud opacities are also noted in the right lower, lingula, and left lower (more marked) lobes which are most likely suggestive of aspiration.
Thickening of the left oblique fissure (trapped or loculated fluid along the fissure) is also seen.
No definite enlarged lymph nodes are appreciated.
Case Discussion
Current CT findings are of esophageal wall malignant mass lesion (biopsy proven SCC) with left-sided pleural invasion in the form of esophagopleural fistula (cT4N0M0) and evidence of pulmonary aspiration as described above.
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