Secondary lung abscess caused by an esophagorespiratory fistula in a patient with a past history of heavy alcohol consumption

TL;DR

A man with a history of heavy alcohol use was found to have a lung abscess caused by an esophagorespiratory fistula, not just from aspiration.

Contribution

The paper emphasizes the need to consider esophageal cancer as a cause of lung abscesses in heavy alcohol users.

Findings

Secondary lung abscesses can be caused by esophagorespiratory fistulas, often linked to esophageal cancer.

Imaging alone may not distinguish between aspiration-related and cancer-related lung abscesses.

Physicians should consider malignancy in patients with heavy alcohol use and lung abscesses.

Abstract

A man in his 60s was ultimately diagnosed with a secondary lung abscess caused by an esophagorespiratory fistula. On admission, however, he had initially been diagnosed with a primary lung abscess because of aspiration, given his history of alcohol use. Secondary lung abscesses can result from various underlying conditions. Among these, esophagorespiratory fistulas are significant causes and are often associated with esophageal cancers. An intriguing aspect of this case is that secondary lung abscesses originating from esophageal cancer can occur under similar conditions as aspiration‐related pulmonary suppuration. Given the difficulty in distinguishing between the two based solely on imaging, physicians should exercise caution when encountering patients with a history of heavy alcohol consumption.

This case highlights the importance of considering malignancy‐related esophagorespiratory fistulas in patients with presumed aspiration‐related lung abscesses and heavy alcohol use.

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