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A middle-age male patient, trumpet blower by occupation, presented with progressive dyspnea with chest heaviness since 2 weeks and low grade fever since 1 week. It started with sudden severe retrosternal chest discomfort and episodic vomiting while practicing trumpet blowing. Patient was toxic with high fever, tachycardia, and tachypnoea. Clinicoradiologically, patient was diagnosed as left-sided hydropneumothorax. Intercostal chest (ICD) tube was inserted at left 5th. intercostal space at midaxillary line following which pus and air came out. Pleural fluid was acidic with high amylase level and polymicrobial growth. Repeat chest X-ray showed partial resolution of left-sided hydropneumothorax. From 4th Day, food particles were noticed in the drainage bag. For screening, 0.1% sterile methylene blue was given orally which came in ICD tube and bag within 24 hours. Subsequently, barium swallow esophagus, CT thorax with oral and intravenous contrast, and upper gastrointestinal endoscopy confirmed left-sided esophagopleural fistula.

Spontaneous esophagopleural fistula in a high-risk individual (trumpet blower)