# Case Report: Esophago-pleural fistula found by the squamous cells from pleural effusion

## TL;DR

A rare case of esophago-pleural fistula was diagnosed in an esophageal cancer patient through pleural fluid analysis, highlighting the importance of this method in cancer diagnosis.

## Contribution

Demonstrates the diagnostic utility of pleural fluid analysis in identifying esophago-pleural fistulas in cancer patients.

## Key findings

- Esophago-pleural fistula was confirmed using methylene blue ingestion and clinical evaluation.
- Pleural effusion containing squamous cells can indicate esophago-pleural fistula in cancer patients.
- Radiation-induced esophagitis increases the risk of fistula formation in esophageal cancer patients.

## Abstract

This report describes a case of esophago-pleural fistula (EPF) in an history of esophageal cancer (EC) patient, initially missed on CT but identified via squamous cells in pleural effusion. EPF is rare and challenging to diagnose due to subtle symptoms. The presence of squamous cells in pleural effusion, typically linked to lung cancer, initially confused the diagnosis given the patient’s EC history. Methylene blue ingestion and clinical evaluation confirmed EPF. This case emphasizes the value of pleural fluid analysis in malignancy patients and the need for vigilance in EC patients, especially with radiation-induced esophagitis.