The case involves a six-month-old African infant who was delivered at term following an uneventful triplet pregnancy and with a birth weight of 3.1kg. The infant presented with a history of recurrent cough, starting on the fourth day of life, which progressed from being dry to wet and occurred mostly during or after breastfeeding. Several weeks after the onset of coughing, the infant began experiencing difficulty in breathing and wheezing. At one month of age, recurrent episodes of fever spikes, ranging from low to high grade, also developed.
Seeking medical help, the infant was initially treated in multiple healthcare facilities as a severe pneumonia case but showed no improvement in symptoms. At four months of age, tracheoesophageal fistula was suspected, leading to the insertion of a nasogastric tube. However, the coughing and breathing difficulties persisted, ultimately resulting in a referral to the present hospital at six months of age.
Upon admission, the infant appeared lethargic, malnourished, and in severe respiratory distress. Physical examination revealed tachypnea (respiratory rate of 78 breaths per minute), oxygen saturation below 85% on room air, intercostal recessions, bronchial breath sounds with bilateral crepitations (more pronounced on the left lung), and normal heart sounds. Other systemic examinations were unremarkable.
Complete blood count results showed leukocytosis with neutrophil predominance and moderate microcytic hypochromic anemia. C-reactive protein levels were significantly elevated. Chest X-ray revealed diffuse cystic changes in the left lung and consolidation in the right lung, raising concerns of a congenital lung malformation. A chest CT scan was subsequently performed, confirming communication between the distal left main bronchus and the distal esophagus (as shown in Image 1). The CT scan's volume-rendered reformatting displayed extensive cystic changes, consolidation, and a fistulous tract (as shown in Image 2).
Based on the diagnostic findings, a diagnosis of bronchoesophageal fistula involving the distal left main bronchus and the distal esophagus, along with severe cystic changes in the left lung and a superimposed infectious process in the right lung, was established. The case was reviewed by a cardiothoracic surgeon who planned for surgical resection. During the operation, sequestered left lung segments containing pus were discovered, along with a bronchoesophageal fistula originating from the lower third of the esophagus, communicating with the left main bronchus. A left pneumonectomy was performed, and the fistula was ligated to address the condition.