A case of congenital esophagobronchial fistula which was diagnosed by detailed medical history taking

Abstract

A 67-year-old man was referred to our hospital because of cough and hemosputum. Chest CT showed inflammatory changes with bronchiectasis at S⁶ of the left lung. Blood serum analysis revealed elevations of beta-D-glucan and aspergillus antigen. He had had pulmonary tuberculosis and two attacks of pneumonia in his infancy. Our diagnosis at this time was bronchiectasis with aspergillosis after old pulmonary tuberculosis. He was treated with an antifungal drug. Three years later, he showed repeat hemosputum and the affected lung area extended. We repeatedly took his medical history in detail. Thirty five years ago, he received a diagnosis of esophageal fistula based on esophagoscopy, and has sometimes coughed after meals. We made a definitive diagnosis of congenital esophagobronchial fistula by esophagography. He underwent excision of the fistula and left lower lobectomy. Detailed medical history taking may help identify congenital esophagobronchial fistula in adults, and esophagography was shown to be a useful method to make a definitive diagnosis.