Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report

Figure 1 Endoscopy image: An opening is seen in the mid-esophagus without active bleeding or clots.

Figure 2 Computed tomography chest. A: Computed tomography lung window axial image shows left lower lobe lung cavitary lesion with multiple nodules in tree-in-bud configuration, a classical sign of lung tuberculosis; B: Chest computed tomography lung window axial image shows multiple mediastinal air pockets anterior to the esophagus, indicating an esophageal fistula; C: Computed tomography chest with IV contrast mediastinal window axial image shows multiple mediastinal necrotic lymph nodes and mediastinal air pocket anterior to esophagus indicating mediastinal tuberculosis and esophageal fistula; D: Computed tomography chest with IV contrast maximum intensity projection coronal reformatted image shows mediastinal bronchial artery aneurysm.

Figure 3 Conventional angiography. A: Selective angiogram of the bronchial artery showing 2 small mediastinal aneurysms; B: Post-coil-embolization angiogram shows complete occlusion of the artery and aneurysms.

Figure 4 Follow-up chest X-ray shows resolution of cavitary lesion and no consolidation. Coils are seen in the mediastinum.