Lung abscess: An unusual presentation of congenital tracheoesophageal fistula without atresia

Tracheoesophageal fistula (TEF) without atresia is rare and usually present s with symptoms from birth. In this report, a 9-year-old boy presented with productive cough of 4 month's duration and was shown to have a right lung abscess seen on chest radiograph. His parents denied earlier respiratory sy mptoms or illnesses. Rigid bronchoscopy showed a fistulous opening of about 1 mm in diameter in the posterior wall of the trachea about 16 cm from the upper incisor teeth. Cannulation with a ureteral catheter demonstrated tha t the fistulous opening communicated with the esophageal lumen. The tracheo esophageal fistula was 1 cm long and was divided through a right supraclavi cular incision. The postoperative period was uneventful, and the patient wa s discharged on the third postoperative day. This case demonstrated that TE F should be considered in any patient presenting with chronic respiratory p roblems even after a prolonged symptom-free period. J Pediatr Surg 33:1817- 1819. Copyright (C) 1998 by W.B. Saunders Company.