Shahab Ahmed, Khurshid Uttra.
Tracheo - esophageal fistula: a rare complication of Tuberculosis.
Pak Armed Forces Med J Jan ;57(2):162-4.

A 25-year-old man was admitted to the hospital because of fever, night sweats, weight loss and violent coughing on swallowing fluids. About three weeks before admission, he was prescribed four drug anti-tuberculosis regime at another facility when his chest radiograph was suggestive of miliary tuberculosis. Two weeks before admission, the patient started having violent cough on drinking fluids. On admission, his temperature was 99°F, pulse rate 96/min, respiratory rate 18/min, blood pressure 110/60 mm Hg, and the oxygen saturation was 97 percent on room air. On auscultation of the chest, there were scant wheezes in both lung fields, but the heart sounds were normal. Therest of clinical examination was normal. Chest radiograph revealed miliary shadowing. The heart appeared normal. Barium swallow examination revealed a communicating track between oesophagus and trachea at the level of T-4, a tracheo-oesophageal fistula. The length of the fistula was 1 cm, with the width at the oesophageal end 6 mm and 3 mm at the tracheal end. The patient started coughing due to the contrast aspiration. Oesophagoscopy revealed a communicating tract in the upper third of the oesophagus. After 3 months of treatment, there was considerable improvement and his coughing on swallowing fluids regressed. Repeat X- ray chest revealed remarkable regression of the tuberculous infection. Repeat barium swallow examination revealed an irregular sinus tract within soft tissues of the mediastinum and has no communication with the trachea. The width of sinus at the oesophageal end now measures 8 mm indiameter with irregularity of the proximal adjacent portion of anterior curvature of oesophagus suggestive of fibrosis.

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