Causes of a fistula between the esophagus and a main airway may include:
(1) carcinoma arising in bronchus or trachea
(2) carcinoma in the upper or mid esophagus
(3) tuberculosis
(4) Candidiasis or other fungal infection in an immunosuppressed patient
(5) penetrating trauma
(6) physical iatrogenic (surgery, intubation, tube placement, etc)
(7) radiation therapy to the thorax and/or chemotherapy
Clinical findings:
(1) paroxysmal coughing after drinking liquid
(2) chronic cough
(3) recurrent pneumonia in the dependent lobes
(4) lesion on anterior wall of esophagus on endoscopy or posterior wall of an airway on bronchoscopy
(5) pain in the neck and/or chest
(6) sputum with particles of food
(7) hemoptysis
(8) hoarse voice
(9) fever
Imaging findings:
(1) recurrent bronchopneumonia
(2) evidence of underlying disease (tumor, tuberculosis, etc.)
(3) leakage of nonionic contrast material
Biopsy at endoscopy or bronchoscopy may demonstrate the underlying process (carcinoma, granulomas, infectious organisms).
