Accepted Manuscript Radiolucent Esophageal Foreign Body Presenting as a Middle Mediastinal Mass and Tracheoesophageal Fistula Joseph M. Baylan, MD Kelly D. Mattix, MD PII: S0022-5223(14)00454-1 DOI: 10.1016/j.jtcvs.2014.04.030 Reference: YMTC 8569 To appear in: The Journal of Thoracic and Cardiovascular Surgery Received Date: 9 October 2013 Revised Date: 17 March 2014 Accepted Date: 14 April 2014 Please cite this article as: Baylan JM, Mattix KD, Radiolucent Esophageal Foreign Body Presenting as a Middle Mediastinal Mass and Tracheoesophageal Fistula, The Journal of Thoracic and Cardiovascular Surgery (2014), doi: 10.1016/j.jtcvs.2014.04.030. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Transcript
Accepted Manuscript
Radiolucent Esophageal Foreign Body Presenting as a Middle Mediastinal Mass andTracheoesophageal Fistula
Joseph M. Baylan, MD Kelly D. Mattix, MD
PII: S0022-5223(14)00454-1
DOI: 10.1016/j.jtcvs.2014.04.030
Reference: YMTC 8569
To appear in: The Journal of Thoracic and Cardiovascular Surgery
Received Date: 9 October 2013
Revised Date: 17 March 2014
Accepted Date: 14 April 2014
Please cite this article as: Baylan JM, Mattix KD, Radiolucent Esophageal Foreign Body Presenting as aMiddle Mediastinal Mass and Tracheoesophageal Fistula, The Journal of Thoracic and CardiovascularSurgery (2014), doi: 10.1016/j.jtcvs.2014.04.030.
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.
Radiolucent Esophageal Foreign Body Presenting as a Middle Mediastinal Mass and Tracheoesophageal Fistula
Joseph M. Baylan MD, Kelly D. Mattix MD
Texas A&M Health Science Center – Scott and White Memorial Hospital, Temple, Texas Department of Pediatric Surgery, McLane Children's Hospital
Corresponding Author: Kelly Mattix 2401 S 31st Street, Temple TX 76508 Phone: 254-724-9138 Fax: 254-724-9139 Email: [email protected]
Word Count: 300
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Esophageal foreign body ingestion occurs more than 100,000 cases per year [1]. When recognized or suspected early, intervention is possible with limited morbidity and mortality. Foreign body (FB) ingestion in adults has a classic history, but may be obscure in the pediatric population. Diagnosis is often aided with radiographic imaging. About 50% of patients have atypical symptoms or are even asymptomatic [2]. An 18 month old male presented secondary to four to six months of stridor and progressive dysphagia with solids and liquids. A chest x-ray and chest computed tomography revealed right sided tracheal deviation and an unusual soft tissue prominence about the upper mediastinum (Figure 1). Laboratory values, tumor markers (AFP, B-HCG), and inflammatory markers (ESR, CRP) were within normal limits. Esophagram revealed a TE fistula (Figure 2).
The patient was taken to the operating room. Rigid bronchoscopy demonstrated tracheal narrowing with inflammation and narrowing at the takeoff of the left mainstem bronchus. The posterior aspect of the trachea showed no evidence of a fistula. Flexible esophagoscopy identified erythematous changes in the distal esophagus consistent with reflux, but no fistula. A right thoracotomy was performed and a mass was noted, which was carefully dissected and was an esophageal diverticulum. Sharp dissection yielded visualization of a FB, an almost fully intact leaf (Figure 3). A 2mm defect in the posterior trachea was noted and repaired primarily.
The patient’s postoperative course was uneventful. A repeat esophogram showed a mild esophageal stricture which responded to dilation and the patient is now asymptomatic.
The diagnosis of retained FB is common, especially in the pediatric population. Delay in diagnosis can lead to complications, such as the tracheoesophageal fistula seen in our patient. Therefore in treating children with atypical presentation and constellation of symptoms, a retained esophageal FB should be included in the differential diagnosis.
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References: [1] Kay M, Wyllie R. “Pediatric Foreign Bodies and Their Management.” Current Gastroenterology Reports 2005; 7(3):212-8. [2] Miller RS, Willging JP, Rutter MJ, Rookkapan K. “Chronic Esophageal Foreign Bodies in Pediatric Patients: A Retrospective Review.” International Journal of Pediatric Otorhinolaryngology 2004; 68, 265-272.
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Figure 1: Axial and coronal chest computed tomography displaying middle mediastinal mass (green marker) with tracheal deviation. Figure 2: Esophagram demonstrating tracheoesophageal fistula (green arrow). Figure 3: Foreign body which caused the fistula, a fully intact leaf.
