A Malignant Connection: Bronchoesophageal-Pleural Fistula in an Elderly Farmer

Bronchoesophageal-pleural fistula (BEPF) is a very rare entity that can present as a late manifestation of oesophageal malignancy. Here, we describe the case of an elderly farmer with no past medical history of note who presented with acute respiratory failure associated with a five-month history of dysphagia and weight loss. Computerised tomography of the thorax showed a connection between the oesophagus, bronchus and pleural space: a bronchoesophageal-pleural fistula. Ultrasound-guided thoracentesis was followed by chest drain insertion into an empyema containing food debris. Histopathological analysis of endoscopic biopsies confirmed an eroding squamous cell carcinoma (SCC) of the oesophagus. An oesophageal stent was inserted to seal off the fistula and broad-spectrum antibiotics were maximised. Ultimately, after four weeks in hospital, palliative therapy was initiated. BEPF remains a very rare and devastating complication of oesophageal malignancy. Endoscopic stenting may provide symptomatic relief.