case_images: PMC11725186_01
case_images: Chest CT scan showing mediastinal abscesses (arrow) between the pneumonectomy cavity, the heart and the diaphragm
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case_images: Fig1
case_images: Eight years after her cancer diagnosis, mediastinitis manifested due to an assumed esophageal tear (Fig. 1).
case_images: Esophagoscopy detecting necrosis in the anterior wall of esophagus and the broncho-esophageal fistula of 5 mm in diameter (arrow)
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case_images: Fig2
case_images: Broncho- and esophagoscopy revealed a BEF with an initial diameter of 5 mm in the left main bronchus 10 mm distally to the carina, and a necrotic esophagus 24-28 cm below the incisors (Fig. 2).
case_images: A-C. Bronchoscopy shows: A: The tracheobronchial stent and signs of an accelerating defect (arrow) of bronchus no longer completely covered by the stent, B: The left main bronchus and the muscle patch of the bronchoplasty (arrow) after 2.5 weeks, C: The bronchoplasty (arrow) completely healed and flush with the original wall after 2.5 years
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case_images: Fig3
case_images: However, the stent implants accelerated tissue necrosis of both the esophagus and the membranous part of the bronchus due to compression of the tissue in between the crossing stents (Figs. 3A and 4A, B). The bronchoplasty was regularly examined and gradually healed (Fig. 3B, C). 150 days after surgery, the patient was discharged to an independent life at home with her family. The last 4 years the left main bronchus has been wide open with a smooth undiscernible bronchoplasty (Fig. 3C).
case_images: A-B. Chest CT scan showing locations and crossing of the esophageal and the tracheobronchial self-expanding covered metal stents (arrow)
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case_images: Fig4
case_images: However, the stent implants accelerated tissue necrosis of both the esophagus and the membranous part of the bronchus due to compression of the tissue in between the crossing stents (Figs. 3A and 4A, B).
case_images: Right-sided thoracotomy, esophagus, esophageal stent and the latissimus dorsi muscle flap
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case_images: Fig5
case_images: Surgery was performed 11 months after the onset of the actual mediastinitis and 77 days after the manifestation of BEF (Fig. 5).
case_images: Sutured neck incision access, esophagostoma and customized blue-line tube to cover and protect the bronchoplasty
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case_images: Fig6
case_images: The oral part of the esophagus was skeletonized off the trachea and the upper mediastinum to the thoracic inlet and exteriorized on the left side of the neck as a stoma (Fig. 6). 
case_images: Venography shows the thrombotic occlusion of the upper veins system
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case_images: Fig7
case_images: Per- and postoperatively, the conditions were complicated by thrombotic occlusion of the vena cava superior, the innominate and the jugular veins (Fig. 7).