Thursday, November 18, 2010

Water Under the Bridge II

This is the second part to a two-part case (scroll down to see the first part).

Unfortunately, the patient described in the last case fails to follow up with a doctor. He finally presents with intractable coughing and recurrent pneumonias. He is intubated and a percutaneous gastrostomy tube is placed for nutrition. He continues to get recurrent pneumonias until finally a diagnostic procedure is done involving methylene blue in the tube feeds.

Challenge: What is the diagnostic procedure? What do you expect?


Madam Roxanne said...

Get a biopsy of the mass to determine malignancy; removal if possible and treatment with chemotherapy.

sid said...

i expect a tracheo-esophageal fistula as a result of local infiltration from the adenocarcinoma..

Craig Chen said...

Water Under the Bridge II

This is tracheoesophageal fistula from direct invasion through the esophageal wall and into the mainstem bronchus. The diagnostic procedure is injection of methylene blue into the tube feeds and suctioning it out of the endotracheal tube.

Sources: UpToDate.