Тhe role of computed tomography in the diagnosis of tracheoesophageal fistulas

Objective. To specify the role of computed tomography (CT) in complex diagnostic of the acquired type of TracheoEsophageal Fistulas (TEFs).

Methods. CT results of 36 (17 men, 19 women, mean age – 53 ± 18) consecutive patients with TEF, presented to N.V. Sklifosovsky Research Institute of Emergency Medicine, were analyzed retrospectively. Multiple screening CT-scans were held in 23 patients (64%) throughout the treatment process.

Results. The sensibility of CT was as high as 92 % with correctly depicted TEFs in 33 of 36 patients. CT imaging demonstrated precise and accurate assessment of TEFs: localization, diameter and length of tracheal defect, type and length of fistulous tract. In 6 observations (18%) the TEF was associated with tracheal stenosis.

In patients with non-traumatic TEFs (n = 10; 30%) CT was of use not only in delineating fistulous tract, but also in detecting possible etiologies, such as esophageal cancer or inflammatory lesions of the mediastinum.

The results of adjacent soft tissues assessment showed various stages of pulmonary inflammation in the majority of patients (n = 25; 69%).

Multiple CT examinations were performed to monitor fistulas, surrounding soft tissues, including evaluation of lung and mediastinal inflammatory changes, and effectiveness of surgical management.

Conclusion. CT is an integral aspect of complex diagnostic in patients with TEFs, that allows to detect fistulas (92% sensitivity) along with the detailed anatomical information upon them. One of the major advantages of the modality is the ability to visualize surrounding structures. Preoperative CT is particularly helpful in deciding the surgical approach, and multiple CT benefits in validation of treatment efficacy.

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