Colosplenopleural fistula: An unusual colonic fistula in a 44-year-old male with Crohn's disease

Abstract

A 44-year-old male with a history of well-controlled human immunodeficiency virus disease and Crohn's disease presented with fever, cough, and left-sided chest pain with radiation to his back. His medical history was notable for a medically managed spontaneous microperforation of the colon at the splenic flexure 30 months prior, and recurrent left-lower-lobe pneumonia with empyema and a splenic abscess within the past 24 months. CT demonstrated a complex left pleural fluid collection with fistulous connection through the spleen and into the large bowel. The patient tolerated a diverting loop ileostomy without complications and was discharged home with plans for resection of the fistulous tract and splenectomy in several months.

Figure 1A

CT demonstrates loculated fluid and air in the left basilar pleural space (thick arrow), communicating with the colon at the splenic flexure (thin white arrow) through a fistulous connection in the spleen (curved arrow).

Figure 1B

The colosplenopleural fistula band likely represents infected fluid and is seen on the sagittal CT image to be continuous with the pleural space adjacent to focally consolidated lung (curved arrow).

Figure 1C

More medially, the low-attenuation fistulous tract through the spleen can be seen with direct extension to the colon at the splenic flexure (white arrow).