Cardiac arrest due to massive aspiration from a broncho-esophageal fistula: A case report

Figure 1 Chest X-ray. A: Chest X-ray on the left was obtained one day prior to cardiac arrest which shows bibasilar atelectasis; B: Chest X-ray on the right obtained following episode of cardiopulmonary arrest showing significant patchy airspace opacities occupying most of left hemithorax.

Figure 2 Flexible bronchoscopy. A: Day 1: Two-centimeter bronchoesophageal fistula (asterisk) with adjacent yellow tinged devitalized mucosa on the posterior wall of left main bronchi; B: Day 8: Further delineation of fistulous track (asterisk) with necrotic mucosa and well-defined borders. LMB: Left main bronchi; RMB: Right main bronchi.

Figure 3 Flexible bronchoscopy at 17 wk. A: Visualization of tracheostomy tube (asterisk) shortly after bronchoscope is advanced through vocal cords; B: Esophageal lumen visualized at the level of mid-trachea confirming TEF. Flexible Bronchoscopy at 7 wk; C: Protruding esophageal stent through left main bronchi BEF. Esophagoduodenoscopy at 28 wk; D: Visualization of tracheostomy tube (asterisk) through a combined lumen of the esophagus and trachea at 14 cm; E: Proximal end of the esophageal stent located below the end of the tracheotomy at 23cm with a double lumen track, esophagus at 8 o’clock and trachea at 2 o’clock; F: Complete obliteration of esophageal stent due to in-growth of tissue at 35 cm (asterisk); G: Schematic diagram. LMB: Left main bronchi; TEF: Tracheoesophageal fistula; BEF: Bronchoesophageal fistula.

Figure 4 Esophagoduodenoscopy. Extensive esophageal esophagitis with devitalized mucosa (asterisk) and deep brownish black ulcers (arrowhead).