Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

An Esophago-Pleural Fistula in a Case of Non-Resolving Pneumonia in a Patient With a History of Lung Cancer FREE TO VIEW

Kyle Long, MD; Marina Dolina, MD
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York Hospital, York, PA

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

Chest. 2016;150(4_S):748A. doi:10.1016/j.chest.2016.08.843
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Esophageal Fistulas are uncommon complication of lung cancer. Most commonly fistula fistula tract formation is seen in esophageal malignancies invading trachea or left mainstem bronchus. Time from initial symptoms to diagnosis is critical in decreasing morbidity and improving survival in these patients.

CASE PRESENTATION: A 72-year-old man presented 3 years after surgical resection for non-small cell lung cancer in his right lower lobe. Patient presented with complaints of fatigue and weight loss. Initial chest imaging with X-ray and CT showed a new right lower lobe pneumonia for which he was treated with oral antibiotics. Patient presented to ED after failing outpatient antibiotics in sepsis. Repeated CT of his chest showed cavitation concerning for obstructive pneumonia from recurrence of lung cancer. CT-Guided Biopsy of the mass was negative for malignancy. Patient continued to have progressive weight loss and fatigue despite treatment with several courses of antibiotics. Patient underwent NAVI-Bronch which revealed squamous cell carcinoma with evidence of obstruction of the right lower lobe with bacterial cultures positive for Klebsiella. Patient also complained of dysphagia and underwent barium esophagram, which revealed a fistula tract leading into the right lower lung. EGD performed and esophageal stent was placed to bypass the area of the fistula. The patient was then started on a chemotherapy regimen prior to being discharged home. At the time of submission the patient is 6 months post stent placement and continuing to undergo chemotherapy with success.

DISCUSSION: In this patient fistula formation was a late complication of untreated lung cancer. Most of the cases of esophago-pleural fistula result in rapid patient demise. This case demonstrates the importance of proper diagnosis and at the time of presentation, so appropriate intervention can substantially decrease disease symptom burden and improve patient survival.

CONCLUSIONS: Early consideration and identification of extra-pulmonary manifestations of lung cancer including the fistula formation can both aid in rapid intervention and prevention of further complications in patients that already have a significant chance of poor outcome due to lung cancer.

Reference #1: Isr Med Assoc J. 2007 Feb;9(2):125. Malignant esophagopleural fistula. Shavit L1, Sella T, Grenader T.

Reference #2: Clin Endosc. 2013 Jan;46(1):91-4. doi: 10.5946/ce.2013.46.1.91. Epub 2013 Jan 31. A case of spontaneous esophagopleural fistula successfully treated by endoscopic stent insertion. Kang GH1, Yoon BY, Kim BH, Moon HS, Jeong HY, Sung JK, Lee ES.

Reference #3: Fluoroscopic management of a metastatic esophagopleural fistula. Al-Mufarrej F1, Gharagozloo F, Margolis M, Tempesta B. J Am Coll Surg. 2009 Sep;209(3):413-4. doi: 10.1016/j.jamcollsurg.2008.12.036. Epub 2009 Apr 24.

DISCLOSURE: The following authors have nothing to disclose: Kyle Long, Marina Dolina

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