Figure 19a. Tracheoesophageal and bronchoesophageal fistulas. (a) Lateral radiograph from barium esophagogram in a 61-year-old man with esophageal cancer shows contrast agent delineating tracheoesophageal communication (arrowhead). Note widening of tracheoesophageal stripe (*) and mass effect on the trachea from tumor. (b) Lateral radiograph from barium esophagogram in a 61-year-old man with recurrent pneumonia shows fistula (arrow) between esophagus and airway that was secondary to histoplasmosis. (c) Reformatted oblique transverse multi-detector row helical CT scan in a 47-year-old man with bronchogenic carcinoma shows irregular fistulous tract extending from the left bronchial tree (black arrowhead) to the esophagus (black arrow). Five standard transverse CT images (not shown) were needed to sequentially demonstrate the oblique course displayed on this single reformatted image. Note oral contrast agent (white arrow) in segmental bronchus and peripheral airspace consolidation (white arrowhead). The patient was treated with a covered esophageal stent.