Tracheal-Mediastinal Fistula Post-chemoradiation Therapy

INTRODUCTION A 52-year-old male presented to the emergency department with chest pain, shortness of breath and hemoptysis that had been worsening over the past two days. Past medical history included a history of non-small cell lung carcinoma, which he had completed radiation therapy approximately four months prior and was currently undergoing chemotherapy. Significant vitals upon presentation included a respiration rate of thirty-six breaths/min and peripheral oxygen saturation measuring 80%. Physical examination revealed a cachectic male appearing older than his actual age, alert and oriented to person, place and time with rhonchi throughout his lung fields and decreased breath sounds on the right. He was started on non-invasive biphasic positive airway pressure with mild improvement of clinical status. An anteriorposterior chest radiograph was preformed and prior computed tomography of the chest was reviewed (Figures 1, 2). Computed tomography of the chest was also repeated on the day of presentation (Figure 3). Lakeland Regional Medical Center, Department of Emergency Medicine, St. Joseph, Michigan