• Dong Ho Yoo, Min Soo Choi, Byeong Ju Lee, Yong Beom Shin, Jin A Yoon, and Sang Hun Kim.
• Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital.
• Medicine (Baltimore). 2021 Apr 2; 100 (13): e25349e25349.

RationaleVideofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet.Patient ConcernsA 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since.DiagnosisVFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia.InterventionVFSS was performed in this case.OutcomesIn the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery.LessonsThis case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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