Wednesday, 15 July 2015

xrayoftheweek 28: what's the story behind this cine clip?

This week's #xrayoftheweek is this cine clip of a fluoroscopy study - from this clip, can you work out:
1. what treatment the person has had before?
2. what is the current complication?

The clip shows that there are stents within both the left and right main bronchi. This is a water soluble contrast swallow study. When the contrast reaches the trachea just above the carina, it flows into the left main bronchus and then refluxes retrogradely into the trachea and right main bronchus, suggesting that there is a tracheo-oesophageal fistula. 

The stents were placed to maintain the airway in the presence of a large mediastinal mass. Due to recent increasing dysphagia and recurrent episodes of aspiration pneumonia, a water soluble contrast swallow study was arranged - this confirms that there is a fistula which accounts for the symptoms. This CT image shows the fistula between the left main bronchus and oesophagus:


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