A Rare Case of Aeroportia Due to Acute Gastric Dilatation - when the Radiologist Goes beyond the Imagess

Abstract

Background & Aims: The development of an esophagorespiratory fistula (ERF) in patients with esophagealcancer (EC) is associated with poor prognosis. We observed a high rate of vocal fold paralysis (VFP) in patientswith ERF. Data on prevalence and complications of VFP in ERF are lacking. The present study investigated theincidence of VFP in patients with malignant ERF and examined possible risk factors and the impact on survival.Methods: We performed a retrospective case-control study of 46 institutional cases of EC patients with ERFin a time period of eleven years. Patients were matched to 92 randomly selected controls (EC patients withoutERF) in a 1:2 fashion for tumor localization and histology. Demographics, clinical characteristics, recurrence,treatment modalities as well as survival were analyzed.Results: Esophageal cancer patients with ERF developed more often VFP than EC patients without ERF (59%vs. 21%; p=0.02; odds ratio (OR) 4.9). Esophageal cancer patients with ERF had a more pronounced weightloss (7.1 vs. 11.5 kg; P = 0.008), as well as higher rates of esophageal (p=<0.001; OR 22.9) and tracheal stenting(p=<0.001; OR 76.8). Proximal tumor growth (p=0.004; OR 7.9), fistula formation to the trachea (p=<0.001;OR 17.2) and recurrent disease (p=0.04, OR 4.7) was associated with VFP development in EC patients withERF. Vocal fold paralysis in ERF did not adversely affect five-year survival.Conclusions: Vocal fold paralysis is a common complication in more than half of the patients with ERF inEC. It is associated with proximal tumor growth, fistula formation to the trachea and disease recurrence, butdoes not influence survival.