Pulmonary tuberculosis (PTB) is a common infectious disease worldwide. However, mediastinal tuberculous lymphadenitis complicated by oesophageal involvement and oesophago-respiratory fistula is now uncommon due to improved anti-tuberculous regimes and better general awareness. The overall incidence of acquired oesophago-respiratory fistula due to infection is low, and therefore, the lesion is not often a frontrunner in differential diagnosis. Still, tuberculous oesophago-respiratory fistulae can potentially occur in patients with retroviral disease, as they tend to have atypical and more virulent manifestations. In this study, we report the case of multiple oesophago-respiratory fistulae in a patient with PTB and retroviral disease, and highlight the computed tomography features of these lesions as an atypical presentation of PTB in retroviral disease. Clinicians should suspect oesophago-respiratory fistulae if patients present with Ono’s sign, and remain particularly vigilant for patients with underlying PTB and retroviral disease, as early diagnosis and treatment could help to reduce mortality.
Adult ; Diagnosis, Differential ; Esophagus ; physiopathology ; Fistula ; diagnosis ; Humans ; Lung ; pathology ; Male ; Radiography, Thoracic ; Retroviridae ; metabolism ; Tomography, X-Ray Computed ; Trachea ; physiopathology ; Treatment Outcome ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; complications ; diagnosis

Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.
Adult ; Case Report ; Deglutition Disorders/*etiology ; Diagnosis, Differential ; Esophageal Neoplasms/*diagnosis ; Esophagoscopy ; Esophagus/pathology/radiography ; Female ; Human ; Mediastinal Diseases/*complications/*diagnosis ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node/*complications/*diagnosis