Spontaneous Esophagopleural Fistula in A High Risk Individual (Trumpet Blower)

A middle aged male patient, trumpet blower by occupation presented with progressive dyspnea with chest heaviness for 2 weeks and low grade fever for 1 week. It started with sudden severe retrosternal chest discomfort and episodic vomiting during practicing trumpet blowing. Patient was toxic with high fever, tachycardia and tachypnoea. Clinicoradiologically patient was diagnosed as left sided hydropneumothorax. Intercostal chest tube was inserted at left 5th. intercostal space at midaxillary line following which pus and air came out. Pleural fluid was acidic with high amylase level and polymicrobial growth. Repeat chest x-ray showed partial resolution of left sided hydropneumothorax. From 4th. day food particles were noticed in the drainage bag. For screening 0.1% sterile methylene blue was given orally which came in ICD tube and bag within 24 hours. Subsequently barium swallow esophagus, CT thorax with oral and intravenous contrast and upper gastrointestinal endoscopy confirmed left sided esophagopleural fistula. Bangladesh J Medicine Jan 2017; 28(1) : 41-45