Esophageal Lung-Clinical Images.

Esophageal lung (EL) is a highly rare anomaly, wherein the bronchus of a lung connects directly with the esophagus. Repeated lower respiratory tract infection (LRTI) is the hallmark of this condition. We present the clinical images of a 5-month-old boy who presented with repeated LRTI since birth. On evaluation, EL was diagnosed. Excision of the lung with abnormally communicating bronchus and primary repair of the esophagus was curative.

INTRODUCTION

Esophageal lung (EL) is a sporadic form of bronchopulmonary foregut malformation first described in 1960 by Keeley et al.[1] Till date, <25 case reports have emerged in the English literature.[2] In this anomaly, one of the bronchi communicates directly with the esophagus instead of the trachea. The right side lung is frequently involved, possibly owing to the proximity of the right bronchus to the esophagus. The presentation is usually with repeated episodes of pneumonia, and EL is detected during the evaluation for recurrent pneumonia.

CASE REPORT

A 5-month-old male child presented with recurrent pneumonia. The apex beat was in the right parasternal area, and there was no air entry on the right hemithorax. The skiagram showed an opaque right hemithorax. A contrast-enhanced computed tomography scan revealed a small collapsed right lung being supplied by the pulmonary artery and drained by the pulmonary vein [Figure 1]. The right-sided main bronchus was not identifiable.

Figure 1

Contrast-enhanced computed tomography of the patient showing a small volume right hemithorax with ipsilateral mediastinal shift (a-c). However, the collapsed small lung parenchyma is seen to be supplied by a small pulmonary artery (arrow in b) and drained by small pulmonary veins (arrow in c). Coronal maximum intensity projection image shows the small right pulmonary veins (arrow in d)

A contrast esophagogram showed prompt delineation of the right bronchial subdivisions. A communication of the lung with esophagus was established at the junction of middle and lower one-third of the intrathoracic esophagus [Figure 2].

Figure 2

Contrast esophagogram is showing the prompt delineation of the right bronchial subdivisions in (a) anteroposterior and (b) lateral view

The child underwent an exploratory thoracotomy. The preoperative findings were confirmed. The bilobed lung was nonaerated and had a liver-like consistency [Figure 3]. There was a direct communication between the esophagus and the lung across a short bronchial stump [Figure 3].

Figure 3

The intraoperative images are showing (a) the nonaerated lobes of the right lung and (b) the communication between the lung and esophagus

The communication was taken down, and the defect in the esophagus was repaired with interrupted 5-0 Polyglactin sutures over a 10 Fr nasogastric tube. The child made an uneventful recovery. The histopathological examination demonstrated the presence of respiratory epithelium and confirmed the diagnosis of EL. The child is currently thriving well and is asymptomatic after 18 months of the operation.

Most of these patients have other associated congenital malformations, mainly esophageal atresia or cardiac anomalies.[34] It closely mimics pulmonary sequestration (PS) radiologically; however in PS, blood supply is of systemic origin unlike the pulmonary artery in EL as in our case. Being a rare anomaly, a close index of suspicion is necessary for diagnosis. A history of recurrent pneumonia and relevant radiological studies should clinch the diagnosis in the majority of such cases. The clinical images provided are expected to help understand the abnormal anatomy and surgical repair in EL. Management is excision of the involved lobes along with the abnormally communicating bronchus and primary repair of the esophageal defect.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.