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138.e2 Bronchoesophageal/Tracheoesophageal Fistula

Bronchoesophageal/Tracheoesophageal Fistula Client Education
Sheet
VetBooks.ir Initial Database

• Regurgitation
BASIC INFORMATION
• Anorexia, lethargy, depression • CBC: inflammatory leukogram; mild
Definition • Tachypnea, increased respiratory effort nonregenerative anemia possible (anemia of
A communicating tract between the esophagus • Weight loss chronic inflammatory disease)
and a bronchus or between the esophagus and • Thoracic radiographs may reveal
the trachea PHYSICAL EXAM FINDINGS ○ Localized alveolar, interstitial, or bron-
• Cough chial changes; the right caudal and right
Synonym • Fever middle lung lobes are most commonly
Esophageal fistula • Tachypnea, increased respiratory effort affected.
• Increased bronchovesicular sounds, focal ○ Esophageal foreign body
Epidemiology crackles, or diminished breath sounds from ○ Esophageal diverticulum
SPECIES, AGE, SEX pleural effusion may be appreciated during ○ Pleural fluid
• An uncommon disease that occurs primarily thoracic auscultation; thoracic auscultation
in dogs; occasional cases in cats have been can be normal. Advanced or Confirmatory Testing
reported. • Contrast esophagram: demonstrates the
• Predominantly young dogs (<7 years old) Etiology and Pathophysiology fistula in most cases. A contrast esophagram
reported, although patients of any age can • Congenital with fluoroscopy is considered more sensitive
be affected. ○ Failure of tracheobronchial tree to com- for detecting small fistulas and for differ-
• In people, diagnosis of congenital broncho- pletely separate from gastrointestinal tract entiating a fistula from aspirated contrast
esophageal or tracheoesophageal fistula may during embryologic development agent.
not be made until adulthood. • Acquired (most common form of broncho- • Esophagoscopy and bronchoscopy are
esophageal fistula) considered less sensitive than contrast
GENETICS, BREED PREDISPOSITION ○ Esophageal perforation from an esophageal esophagrams but will be helpful in some
• Most cases have occurred in small-breed dogs, foreign body is the usual cause. The cases. Bronchoscopy can help rule out other
possibly associated with the increased preva- foreign body can perforate the esophagus causes of focal pneumonia such as respiratory
lence of esophageal foreign bodies in small- itself, or perforation may result from foreign bodies or bronchial neoplasia.
breed dogs. Conceivably, however, any breed pressure necrosis of the esophagus. • Respiratory washes (transtracheal wash,
could be affected in the presence of appropri- ○ Esophageal diverticulum formation that bronchoalveolar lavage) will be important
ate risk factors. predisposes to entrapment of an esopha- in some cases, particularly those with a
• Congenital bronchoesophageal fistula geal foreign body and subsequent perfora- history of having received multiple antimi-
has been described in dogs and cats; the tion of the esophagus can also lead to crobials, to guide appropriate antimicrobial
genetic basis for the disease has not been bronchoesophageal fistula. selections.
established.
DIAGNOSIS TREATMENT
RISK FACTORS
• An esophageal foreign body is the single Diagnostic Overview Treatment Overview
biggest risk factor for the subsequent develop- The diagnosis should be suspected in • Remove diseased lung, and close esophageal
ment of a bronchoesophageal/tracheoesopha- patients with a history of esophageal foreign defect.
geal fistula. bodies and recurrent bouts of antimicrobial- • Control pulmonary infection.
• Although esophageal neoplasia is uncommon responsive respiratory disease or patients
in dogs and cats, in people, esophageal that cough in association with food or water Acute General Treatment
neoplasia or its treatment is a risk factor for ingestion. Surgical resection of the involved lung lobe
bronchoesophageal or tracheoesophageal with primary closure of the esophageal
fistula formation. Differential Diagnosis defect; remove esophageal foreign body if
Other causes of chronic cough: present
ASSOCIATED DISORDERS • Aspiration pneumonia secondary to other
• Focal pneumonia/aspiration pneumonia esophageal diseases Chronic Treatment
• Esophageal diverticulum • Other causes of recurring pneumonia such Antimicrobials for pneumonia, with selection
as seen with immune deficiencies (e.g., best guided by culture and sensitivity testing
Clinical Presentation immunoglobulin A [IgA] deficiency) or of respiratory washes, especially for patients
DISEASE FORMS/SUBTYPES abnormalities in pulmonary defense mecha- that have received repeated courses of
• Congenital nisms (e.g., ciliary dyskinesia/immotile cilia antimicrobials.
• Acquired syndrome)
• Respiratory foreign bodies Possible Complications
HISTORY, CHIEF COMPLAINT • Respiratory parasites • Complications of treatment or the primary
• Chronic cough is the most common clinical • Respiratory neoplasia disease have not been described for those
sign; coughing after drinking water or eating • Inflammatory respiratory diseases (e.g., animals that survive.
is seen in some but not all cases. The cough chronic bronchitis, eosinophilic broncho- • Esophageal stricture after foreign body
is often responsive to therapy with antimi- pneumopathy, collapsing trachea, interstitial removal would be possible.
crobials but typically recurs at some point lung diseases, infectious disease), many of • Complications of untreated bronchoesopha-
after cessation of antimicrobial therapy. which affect older rather than younger dogs geal fistula include persistent or recurring
• Hemoptysis is also possible. or are associated with more diffuse pulmo- pneumonia, pleuritis, pyothorax, sepsis, and
• Dysphagia nary parenchymal disease pulmonary parenchymal abscessation.

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