Chronic cough suspected as pneumothorax and identified as esophago-pleural fistula

Chronic cough, defined as a cough lasting 8 weeks or longer in adults, presents a significant diagnostic challenge due to the complexity of underlying causes. Unexplained chronic cough accompanied by shortness of breath that does not improve with chest tube placement administration may be suspected of esophago-pleural fistula. A 54-year-old woman experienced a 2-month chronic cough, shortness of breath, and chest and abdominal pain. Initially treated symptomatically, she was later diagnosed with right-sided pneumothorax. The patient underwent chest tube placement, fluid therapy, antibiotics, gastroprotective agents, and breathing exercises. A chest CT scan suggested an esophago-pleural fistula, although this diagnosis was suspected radiologically and not definitively confirmed by esophagography or endoscopy, and she was referred for thoracic surgical intervention. This case highlights the importance of a comprehensive diagnostic approach in chronic cough with systemic symptoms. Pneumothorax with esophago-pleural fistula is a rare but serious condition requiring early stabilization, empirical antibiotic therapy, and further imaging evaluation. Esophago-pleural fistula should be considered in cases of atypical pneumothorax with gastrointestinal symptoms. Early diagnosis, appropriate intervention, and multidisciplinary collaboration are key to successful treatment.