Abstract Introduction Tracheoesophageal fistula (TEF) in adults is most often secondary to malignancy or iatrogenic injury. Delayed presentation decades after thoracic radiation is exceedingly rare. We describe a patient with remote history of chemoradiation for non-Hodgkin’s lymphoma (NHL) who developed progressive dysphagia, dyspnea and cough and was found to have findings concerning forTEF. Case Presentation A 70-year-old male with hypertension, hyperlipidemia, prior stroke, and history of NHL treated with chemotherapy and radiation 20 years earlier in China presented with six months of progressively worsening dysphagia, dyspnea and cough. He was unable to tolerate solids and had increasing difficulty with liquids but denied chest pain, hemoptysis, or weight loss. Patient was sent to the emergency department after an outpatient barium esophagogram showed contrast within the left tracheobronchial tree consistent with a possible TEF. On admission, vital signs were stable. Laboratory work revealed mild normocytic anemia (Hb 12.8 g/dL). Chest radiograph demonstrated aspirated oral contrast in bilateral lower lobes (left right). CT chest with oral and IV contrast revealed contrast in left greater than right lower lobes, outpouching of the esophagus in closer proximity to the posterior aspect of the lower trachea with endoluminal contrast, as well as questionable direct connection with left main bronchus. Flexible bronchoscopy identified a small fistulous tract just beyond the left upper lobe subcarina. EGD confirmed a mucosal irregularity, but no clear endoscopic evidence of fistulous opening in the esophagus. Given concerns for aspiration, the patient was made NPO and initiated on total parenteral nutrition via PICC line. Multidisciplinary discussions with gastroenterology, pulmonology, and thoracic surgery teams were held. Repeat EGD one week later showed no endoscopic evidence of persistent TEF, suggesting possible spontaneous closure or intermittent tract. He was transitioned to a pureed diet with aspiration precautions and tolerated oral intake. Discussion Acquired TEF following decades after radiation is an uncommon but serious late complication, often resulting from ischemic necrosis and fibrosis of the tracheoesophageal wall. Clinical presentation can be insidious, and imaging findings may fluctuate with mucosal sealing or inflammation. Diagnosis requires a combination of contrast studies, CT imaging, and endoscopy—often repeated when initial findings are inconclusive. Optimal management demands individualized, multidisciplinary coordination involving pulmonology, gastroenterology, and thoracic surgery. Conclusion This case underscores the potential for delayed radiation-induced TEF decades after therapy. Progressive dysphagia in such patients should prompt comprehensive, repeat evaluation and collaborative management to prevent aspiration and guide long-term care. This abstract is funded by: None
Gabrichidze et al. (Fri,) studied this question.