Computed tomography and barium swallow findings of esophageal squamous cell carcinoma with suspected bronchoesophageal fistula in a patient with chronic graft-versus-host disease: A case report

Secondary esophageal squamous cell carcinoma is an uncommon but recognized late malignancy after allogeneic hematopoietic stem cell transplantation, particularly in patients with chronic graft-versus-host disease. We report a 33-year-old man with T-cell lymphoma treated approximately 8 years earlier with chemotherapy, radiotherapy, and allogeneic hematopoietic stem cell transplantation, complicated by chronic cutaneous and ocular graft-versus-host disease. He developed 6 months of progressive dysphagia and weight loss; upper endoscopy with biopsy confirmed esophageal squamous cell carcinoma, and he completed 6 cycles of preoperative chemotherapy. When severe oral intolerance prompted admission, barium swallow demonstrated an irregular short-segment mid-thoracic esophageal stricture at the carina with mild proximal dilatation and approximately 2.5 cm of linear contrast extravasation toward the left bronchial tree, raising suspicion for a bronchoesophageal fistula. Chest computed tomography showed an approximately 70-mm elongated mid-esophageal mass with proximal fluid-filled dilatation. Contemporaneous neck and abdominopelvic computed tomography showed no definite distant metastasis. No bronchoscopy or repeat endoscopy confirming the fistula was documented; the fistula therefore remained suspected. Esophagectomy was planned; nutritional consultation recommended parenteral support, and central venous access was established. The patient subsequently deteriorated and died after cardiopulmonary arrest before any documented esophagectomy. This case emphasizes the complementary roles of contrast esophagography and computed tomography and the importance of distinguishing malignant obstruction and fistulization from benign graft-versus-host disease-related esophageal strictures in post-transplant patients with new or progressive dysphagia.