Tracheoesophageal Fistula-A Manifestation of Esophageal Cancer

A 78-year old male with a past medical history of treated tuberculosis, tobacco abuse (greater than 75 pack-years), and alcohol abuse, presented with complaints of hemoptysis and odynophagia. His vital signs were normal. Lab work was within normal limits except for haemoglobin of 6.9 mg/dL, international normalized ratio of 1.27, and pre-albumin <3 mg/dL. Physical examination revealed severe cachexia, diffuse wheezing and rhonchi on auscultation, most pronounced in the right middle and lower lung fields. A CT scan (Images below) showed the presence of a tracheoesophageal fistula. He underwent an esophagogastroduodenoscopy, during which biopsies of the proximal and mid-esophagus were obtained. Pathology revealed invasive, moderately differentiated, keratinizing squamous cell carcinoma.  An esophageal metal stent was placed for palliation and patient was discharged under hospice care.