A Rare Pulmonary Complication of Esophageal Carcinoma: A Case of an Acquired Esophago-Pulmonary Fistula

Esophageal-respiratory fistulae are abnormal communications between the esophagus and the respiratory tract, most commonly appearing as tracheoesophageal or bronchoesophageal fistulas. Esophago-pulmonary fistulas represent a rare subtype, typically associated with malignancy, and may lead to severe complications such as lung abscesses. We report a case of a 58-year-old male patient who presented with a two-week history of fever, foul-smelling mucoid sputum, dyspnea, dysphagia, and weight loss. Imaging revealed a distal esophageal mass with a fistulous communication into the right lower lobe and a lung abscess. Bronchoscopy confirmed purulent secretions, and upper gastrointestinal endoscopy showed a malignant esophageal rent. Biopsy diagnosed squamous cell carcinoma. The patient was started on empirical antibiotics, antifungals, and total parenteral nutrition. Positron emission tomography computed tomography (PET-CT) demonstrated a distal esophageal tumor with a possible skip lesion and a direct fistula into the abscess cavity. A covered self-expandable metallic stent (SEMS) was inserted for palliation. On follow-up, tumor ingrowth above the stent with a persistent leak required consideration of secondary stenting. The patient was deemed unfit for radiotherapy and was referred for chemotherapy. This case highlights an uncommon but life-threatening complication of esophageal carcinoma. Prompt diagnosis through imaging and endoscopy is essential to guide appropriate palliative interventions. In inoperable cases, stenting combined with supportive care remains the mainstay of treatment. Recognizing this rare presentation is important for improving outcomes in patients presenting with overlapping gastrointestinal and pulmonary symptoms.