Tracheo-oesophageal fistula diagnosed with multidetector computed tomography.

A 61-year-old man presented acutely to hospital with respiratory distress. He had a background history of recurrent respiratory tract infections. Chest radiograph showed bilateral lower lobe air-space opacification. Subsequently the patient developed acute respiratory decompensation and respiratory arrest requiring endotracheal intubation. The patient was admitted to the intensive care unit, and intensive care unit staff noted that unusually high positive end expiratory pressure values were required to maintain adequate oxygenation. Another notable finding was repeated reflux of air through the patient's oropharynx. The endotracheal tube was replaced with a larger calibre endotracheal tube without improvement. The possibility of tracheooesophageal fistula was considered and the patient underwent flexible bronchoscopy and contrast oesophagography, none of which showed a tracheo-oesophageal fistula. Clinical concern for tracheooesophageal fistula persisted and the patient continued to require mechanical ven...