Tracheal Fistula
Jonathan H. Chung, MD
DIFFERENTIAL DIAGNOSIS
Common
Congenital
Neoplasm
Tracheal or Esophageal Cancer
Lymphoma
Less Common
Trauma
Blunt or Penetrating Trauma
Iatrogenic
Endoscopy
Surgery
Chronic Endotracheal Intubation
Infection
Inflammation
Radiation
Corrosive Ingestion
Chronic Foreign Body
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
In pediatric patients, tracheoesophageal fistulas (TEF) almost always congenital
In adult patients, TEF most often due to malignancy and trauma
Secondary findings in TEF: Esophageal dilation, aspiration in dependent portions of lungs
Helpful Clues for Common Diagnoses
Congenital
Abnormal division of foregut into separate tracheal and esophageal lumens
High association with other congenital conditions including VACTERL
Most commonly associated with proximal esophageal atresia with distal TEF (over 80% of congenital cases)
Neoplasm
History or imaging findings of tracheal or esophageal cancer
Focal chronic soft tissue thickening in association with TEF
Superimposed radiation potentiates local inflammation, predisposing to TEF
Helpful Clues for Less Common Diagnoses
Trauma
History of imaging findings of blunt or penetrating trauma
History of recent procedure in region of TEF
Chronic intubation: Posterior wall erosion caused by excessive cuff pressures or abrasion by tube
Infection
Tuberculosis or fungal infection
Superimposed pulmonary opacities (nodular opacities) with low-density lymphadenopathy
Inflammation
Radiation: Adjacent radiation changes in lungs
Foreign body in airway; cross-sectional imaging highly sensitive
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