A rare image of post-CTRT iatrogenic tracheoesophageal fistula

A tracheoesophageal fistula may occur due to direct extension of tumour tissue in the trachea and oesophagus, pressure necrosis by a tracheostomy tube in apposition to a nasogastric tube, or tracheoesophageal injury due to other sorts of instrumentation. Bevacizumab is known to cause post-chemotherapy tracheoesophageal fistulae. We present barium swallow x-rays of a female with squamous cell carcinoma of the middle third of the oesophagus; she was being treated weekly with a 6-week regimen of concurrent chemoradiotherapy (CTRT). The x-rays show the formation of a tracheoesophageal fistula at the mid-oesophagus with dye traversing in both directions. It is likely that the tracheoesophageal fistula was formed by trauma due to food matter on a friable sloughed off post-CTRT oesophageal mass. In the majority of cases, these fistulae do not form during chemoradiotherapy, but manifest about six months later. However, in the case presented herein, the fistula was formed in the immediate post-radiation phase.