Sasaki Mari, Mochizuki Hideaki, Takahashi Hideki
Division of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital, Japan.
Intern Med. 2013;52(7):795-9. doi: 10.2169/internalmedicine.52.9191. Epub 2013 Apr 1.
A 26-year-old man visited our clinic because of a persistent cough. Although his chest roentgenography showed no abnormalities, a sputum culture revealed a positive result for Mycobacterium tuberculosis. Computed tomography (CT) prior to antituberculous chemotherapy demonstrated an esophagomediastinal fistula with subcarinal lymphadenopathy. One week after the treatment, he complained of a severe cough exacerbated by swallowing liquid. The development of a bronchoesophageal fistula (BEF) was suggested by esophagoscopy, and was confirmed by CT and bronchoscopy. The present case was unique because the process of BEF development could be followed by CT, and the BEF developed in an immunocompetent patient with relatively mild pulmonary tuberculosis.
一名26岁男性因持续咳嗽前来我院就诊。尽管其胸部X线检查未显示异常,但痰培养显示结核分枝杆菌阳性。抗结核化疗前的计算机断层扫描(CT)显示存在食管纵隔瘘并伴有隆突下淋巴结肿大。治疗一周后,他抱怨吞咽液体时剧烈咳嗽加剧。食管镜检查提示存在支气管食管瘘(BEF),CT和支气管镜检查予以证实。本病例独特之处在于BEF的发展过程可通过CT追踪观察,且BEF发生在一名免疫功能正常、肺结核病情相对较轻的患者身上。