SHM Converge Scientific Abstract ePoster Gallery-Esophagopleural Fistula Presenting as Loculated Pleural Effusion in Metastatic Esophageal Squamous Cell Carcinoma

Pdf Summary

This case report describes a 59-year-old man with stage IV esophageal squamous cell carcinoma (ESCC) metastatic to the adrenal glands and brain who presented with pleuritic chest pain, hypoxia, lethargy, hypotension, marked leukocytosis, and acute kidney injury. Initial imaging revealed a large loculated right pleural effusion with a small pneumothorax. He required broad-spectrum antibiotics, vasopressor support, and chest tube placement, which drained 1660 mL of fluid with mixed gram-positive and gram-negative bacteria.<br /><br />Further CT imaging of the thorax with contrast identified an esophagopleural fistula (EPF) arising from the distal esophagus, explaining the persistent pleural collection and hydropneumothorax. Thoracic surgery determined he was not a surgical candidate because of advanced disease progression and overall clinical decline. Despite prior guideline-directed therapy, including FOLFOX, pembrolizumab, docetaxel, and whole-brain radiation, his cancer continued to progress. After goals-of-care discussions, he was transitioned to comfort-focused care.<br /><br />The report emphasizes that ESCC is an aggressive malignancy with early metastatic spread and poor prognosis, and that EPF is a rare but serious complication that may present as recurrent or loculated pleural effusion, chest pain, cough, dyspnea, pneumonia, or subcutaneous emphysema. Diagnosis relies on clinical suspicion and imaging such as contrast CT or barium studies. Management may include drainage, esophageal stenting, or surgical repair when feasible.<br /><br />The main takeaway is that clinicians should maintain a high index of suspicion for EPF in patients with advanced esophageal cancer and persistent pleural effusions. Early recognition and intervention may reduce complications, but in refractory metastatic disease, treatment decisions must balance potential benefit with burden and patient-centered goals of care.

Asset Subtitle

Elaine Ognjanovski

Meta Tag

Author List David Leroy, Elaine Ognjanovski, Niketh Chopra, Rafael Barretto, Raquel Rudy, Rossteen Abbasi

Category Clinical Vignettes

Concept Esophagopleural Fistula

Concept Esophageal Squamous Cell Carcinoma

Concept Metastatic Esophageal Cancer

Concept Pleural Effusion

Concept Loculated pleural effusion

Distinguished Non-Finalist

Presenter Organization Henry Ford Warren Internal Medicine

Presenting Author Elaine Ognjanovski

Track Adult

Keywords

esophageal squamous cell carcinoma

esophagopleural fistula

pleural effusion

hydropneumothorax

metastatic cancer

chest pain

contrast CT

chest tube drainage

pneumothorax

palliative care

Esophagopleural Fistula

Esophageal Squamous Cell Carcinoma

Metastatic Esophageal Cancer

Pleural Effusion

Loculated pleural effusion