A 47-year-old man with a history of advanced oesophageal cancer under concurrent chemoradiotherapy treatment (CCRT) presented with a 10-day history of persistent high-spike fever of 39°C with haemoptysis. He had had worsening of his symptoms for 1 month before presentation, with an associated weight loss of 10 kg.

CT imaging of the chest (mediastinal and lung windows) for fever survey revealed pulmonary abscess formation with right-side pleural empyema in the right lung field (figure 1A) and high suspicion of oesophagobronchial fistula formation after CCRT (figure 1A, B, red arrow). Swallowing videofluoroscopic investigation confirmed oesophagopleural fistula formation with dynamic characteristics of an air–fluid level during iodinated contrast medium swallowing (figure 2, video 1).

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Figure 1

CT imaging of the chest (mediastinal and lung windows) for fever survey showing pulmonary abscess formation with right-side pleural empyema in the right lung field (A) and high suspicion of oesophagobronchial fistula formation after CCRT (A and B, red arrow).

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Figure 2

Swallowing videofluoroscopic study confirming oesophagopleural fistula with dynamic characteristics of an air–fluid level during iodinated contrast medium swallowing (video 1).

Oesophagopleural fistula is a rare condition usually associated with the catastrophic sequelae of oesophageal perforation. It is more common in the right-side pleural space because of the oesophagus being in direct contact with the pleura on the right side, and is found mostly in patients with oesophageal cancer who have undergone CCRT, with an incidence of 5–15%.1 ,2 Oesophageal fistula can further lead to complications in the mediastinum such as mediastinitis, empyema, lung abscess, aspiration pneumonia and fistula formation involving the trachea–bronchial tree, pleura and lung.3 Because of the dismal prognosis with potentially high morbidity and mortality, early diagnosis with multimodality imaging and prompt management is important.3

Because of the patient's poor general condition, no surgical repair was performed. He died from septic shock with respiratory failure 1 week later.