Cardiothoracic Surgery: Cardiothoracic |

Unusual Pathology Causing Cough: Idiopathic Tracheo-Esophageal Fistula FREE TO VIEW

Asad Omar, MD
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St John Providence Hospital, West Bloomfield, MI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A64. doi:10.1016/j.chest.2016.02.067
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SESSION TITLE: Cardiothoracic

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Cough is responsible for about 30 million clinician visits annually in the US. While the most common causes of cough are Upper Airway Cough Syndrome, Asthma, GERD, and medications, it can also be caused by less common causes such as a tracheoesophageal fistula (TEF).

METHODS: Extensive literature reviews suggest TEFs of adult are predominantly due to acquired causes such as malignancy, trauma or prolonged intubations. We report a case of cough in an adult due to a TEF, idiopathic in nature with no underlying etiology.

RESULTS: The patient is a 75 year old male who presented for a 5 month cough recently associated with hemoptysis along with an abnormal CT Thorax at an outside facility. Two courses of Zithromax prescribed by his primary care physician did not alleviate symptoms. No history of post nasal drip, shortness of breath, fevers, or weight loss was reported. Physical examination was unremarkable. An outpatient CT Thorax done recently showed tree-in-bud appearance within left lower lobe with calcific lesions seen within the proximal left mainstem bronchus (LMSB). PFT’s done showed FEV1/FVC of 75%, FEV1 of 80 with no significant change with bronchodilators, TLC of 84, RV of 98, and DLCO of 84. Bronchoscopy showed yellow, mass like densities in the LMSB with inflamed and thickened mucosa noted at the base. The base of the mass also looked necrotic with irregular borders. Bronchial washing and tissue biopsies were obtained from the LMSB. The patient returned to the office after the bronchoscopy with his cough unchanged. All cultures and biopsies from the bronchoscopy came back negative. Given his persistent cough and bronchoscopic findings with negative cultures and biopsies, an esophagram was done which was suggestive of a TEF. A subsequent EGD was unable to locate the fistula but a specialized US guided EGD was successful in locating a TEF. The patient He denied any history of trauma, previous intubations, or specific relation of his symptoms to food intake. He had an expandable stent placed with significant resolution of his symptoms over the following week.

CONCLUSIONS: Cough is a common reason for office visits and while most patients’ underlying cause can be identified with detailed history taking and some tests, others have less common pathologies. Our case represents an adult patient found to have a TEF with no underlying etiology.

CLINICAL IMPLICATIONS: It shows that in patients presenting with cough with no clear underlying cause and failing conservative treatment, TEFs can be considered as a cause.

DISCLOSURE: The following authors have nothing to disclose: Asad Omar

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