Acquired esophagobronchial fistula without Ono's sign and with unusual cause

Abstract

A 60-year-old woman presented with dyspnoea and respirophasic chest discomfort, as well as a history of idiopathic oesophageal diverticulum. Physical examinations showed no evidence of Ono's sign, fever and weight loss. Chest radiograph revealed a right-sided transudative pleural effusion. Barium oesophagogram made a diagnosis of acquired esophagobronchial fistula communicating between oesophagus and bronchus. The oesophagobronchial fistula, causing pleural effusions, was very small and could be caused by idiopathic oesophageal diverticulum. The pleural effusion was removed by thoracentesis, which improved her symptoms. Surgical therapy or covered oesophageal stenting was advised, but she declined. She is followed-up regularly on an outpatient basis.

Figure 1

Posteroanterior chest radiograph before thoracentesis showing a right-sided transudative plural effusion (arrow).

Figure 2

Posteroanterior chest radiograph after thoracentesis showing that the transudative pleural fluid was removed (arrow).

Figure 3

Barium oesophagogram showing an esophagobronchial fistula (arrow) from the oesophagus.

Figure 4

Barium oesophagogram showing the fistula from the oesophagus (arrow) and that barium was filling the right bronchial tree (arrowhead), showing the communication of the oesophagus with the right bronchus.