Multiple infectious esophageal fistulae.

Acquired fistulous communication between the respiratory tract and the esophagus in the adult are most often posttraumatic or secondary to malignant disease. Infectious fistulae, although uncommon, have been described secondary to primary esophageal, mediastinal, or pulmonary processes. Because of better mucosal definition, double contrast esophagography may help determine the origin of the communication and therefore aid in the differential diagnosis. In addition, near-maximal esophageal distension may demonstrate additional fistulae, which if widely separated, suggest an infectious etiology. To our knowledge, no examples of multiple esophagopulmonary communications have been reported in the English literature. We report two such cases in which the barium study correctly predicted an infectious etiology.