Tracheoesophageal Fistula with Tracheal Dilatation in a Patient with
a Tracheostomy Using a Home Mechanical Ventilator

Kim, Byounghoon; Joo, Min Sun; Kim, Yoo Na; Shin, Tae Rim; Park, Sang Myeon; Kim, Dong Gyu; Sim, Yun Su

doi:2014.87.1.87

Korean J Med > Volume 87(1); 2014 > Article

Case Report

The Korean Journal of Medicine 2014;87(1):87-91.
Published online July 1, 2014.
DOI: https://doi.org/10.3904/kjm.2014.87.1.87

Tracheoesophageal Fistula with Tracheal Dilatation in a Patient with a Tracheostomy Using a Home Mechanical Ventilator

Byounghoon Kim¹, Min Sun Joo¹, Yoo Na Kim², Tae Rim Shin¹, Sang Myeon Park¹, Dong Gyu Kim¹, Yun Su Sim¹

¹Division of Pulmonary, Allergy and Critical Care Medicine, Departments of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
²Radiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea

기관절개 상태로 가정에서 인공환기 중에 발생한 기관확장과 기관식도루

김병훈¹, 주민선¹, 김유나², 신태림¹, 박상면¹, 김동규¹, 심윤수¹

^¹한림대학교 강남성심병원 호흡기 알레르기내과
^²한림대학교 강남성심병원 영상의학과

Correspondence:
Yun Su Sim, Tel: +82-2-849-9091, Fax: +82-2-846-4669, Email: simyunsu@hallym.or.kr

Received: 14 August 2013 • Revised: 2 October 2013 • Accepted: 23 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Patients with tracheostomies requiring prolonged home mechanical ventilation are increasing in number rapidly. A tracheoesophageal fistula is a relatively unusual complication, but this case resulted in a fatal outcome. We describe a tracheoesophageal fistula with tracheal dilation in a 72-year-old female who had a prolonged tracheostomy and nasogastric tube, using a home mechanical ventilator. On enhanced CT images, the tracheostomy tube was well located within the trachea with no abnormal finding. However, chest enhanced CT images obtained 5 months later showed marked circumferential wall thickening of the trachea with tiny ulceration, a markedly increased diameter of the tracheal lumen, and a tracheoesophageal fistula. In patients using home mechanical ventilators, the location and cuff pressure of the tracheostomy tube and the nasogastric tube should be evaluated routinely.

Key Words: Tracheoesophageal fistula; Tracheostomy; Mechanical ventilation