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[NEJM临床医学影像]: 支气管食管瘘
2021年05月31日 临床影像, 临床话题 暂无评论

IMAGES IN CLINICAL MEDICINE

Bronchoesophageal Fistula

Pierluigi di Mauro and Vittorio Ferrari

N Engl J Med 2020; 383:e137
DOI: 10.1056/NEJMicm2018535

A 50-year-old man presented to the emergency department with a 5-day history of shortness of breath, chest pain, and a cough. Fifteen days before presentation, he had received a diagnosis of large-cell neuroendocrine carcinoma of the lung with brain metastases. The oxygen saturation was 93% while the patient was breathing ambient air. The physical examination was notable for diminished breath sounds in the right lower lobe, as well as paroxysms of cough after fluid intake. Computed tomography of the chest showed diffuse bilateral interstitial infiltrates, as well as the known lung lesion surrounding the middle third of the esophagus. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. Water-soluble contrast esophagography revealed material passing from the esophagus to the right bronchial tree and ascending to the right main bronchus and trachea as the patient coughed (see video). A diagnosis of bronchoesophageal fistula due to lung carcinoma was made. A covered, self-expanding metal stent was placed in the esophagus, which alleviated the patient’s cough and chest pain. Treatment with chemotherapy was initiated; however, the patient transitioned to hospice care and died 4 weeks after presentation.

一名50岁男性患者因呼吸困难、胸痛、咳嗽5天到急诊就诊。就诊前15天,患者确诊为肺部大细胞神经内分泌肿瘤伴脑转移。吸空气时氧饱和度93%。体格检查发现,右下肺呼吸音减低,进食后阵发性咳嗽。胸部CT显示双肺弥漫性浸润,以及已知的肺部病变包绕食道中1/3。SARS-CoV-2检测结果为阴性。水溶性造影剂食道造影显示造影剂经过食道进入右侧支气管树,且随着患者咳嗽可上升至右主支气管和气管。遂诊断为肺癌继发支气管食管瘘。在食道内放置覆膜自扩张金属支架,混着咳嗽及胸痛症状缓解。后开始进行化疗;但患者最终转入临终关怀病房,于就诊4周后死亡。

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