Esophagopleural fistula

This patient had an esophagopleural fistula secondary to a gunshot wound. The bullet track was from the right shoulder (A: red arrow shows the entry point and dotted lines show the track), through the mediastinum (miraculously missing any vital organs) and finally embedded in the left shoulder (A: green arrow). This resulted in a right pleural effusion for which a drain was placed (B: White arrow shows the drain. Green arrow shows the bullet embedded in the left shoulder). Endoscopy showed the fistula clearly for which a 23mm x 155mm self expanding covered metallic stent was placed (C: Red arrow shows the stent assembly and green arrow shows the fistula opening. D: white arrows show the deployed stent). The patient was reviewed after three months and some polypoid growths were seen near the upper and lower uncovered areas of the stent (E). The stent was removed with forceps (F). A post removal gastrograffin swallow showed no leakage of contrast material (G1 to G4: green arrows in G1 and G4 show the bullet still lodged near the left shoulder).