Tracheoesophageal Fistula from a Gunshot Wound to the Neck

who have had a projectile traverse the mediastinum or neck. Symptoms of tracheoesophageal injury vary depending on the size of the fistula. Coughing attacks after swallowing suggest the presence of tracheal or esophageal injury. However, with smaller fistulas, symptoms may be subtle or may not initially be evident. Thus, urgent performance of thorough clinical, endoscopic, and imaging evaluations is the standard of care for patients with penetrating injuries believed to have traversed the expected course of the aerodigestive tract. The presence and extent of the tracheo esophageal fistula can be diagnosed on esophagography and CT; supplemental information may be acquired with esophagoscopy and bronchoscopy [1]. In addition to direct signs of tracheoesophageal fistula, imaging can also show indirect findings of the communication, such as pneumonia, gaseous distention of the esophagus, pneumomediastinum, and subcutaneous air. In simultaneous injuries of the esophagus and the trachea, repair of the airway can be jeopardized if it becomes infected by the salivary stream from an unrecognized esophageal perforation or from a leaking repair. Treatment of acquired tracheoesophageal fistula is surgical, with complete separation of the two structures and interposition of a muscle flap, if necessary [2‐4]. Imaging can play an important role in the early diagnosis and comprehensive characterization of aerodigestive tract injuries and helps form the foundation of successful therapies [5].