LAUSR

Figure 2. CT demonstrating a posterior mediastinal abscess (arrow). Esophagomediastinal fistula (EMF) is a rare but serious adverse event after trauma or chest surgery. The exact pathophysiologic mechanism is unclear but is presumed to be associated with compressive injury to the esophagus, with subsequent ischemia and inflammation leading to fistula formation. Prompt recognition is crucial because a delay in management increases morbidity and mortality. In this video (Video 1, available online at www.VideoGIE. org), we present a case of an EMF arising from a cervical esophageal diverticulum after blunt chest trauma and surgery. A 39-year-old woman was admitted to the hospital after sustaining blunt trauma to the chest and abdomen in a motor vehicle accident. CT revealed extensive subcutaneous emphysema in the chest wall, pneumomediastinum, and bilateral pneumothoraces (Fig. 1). She underwent bilateral chest tube placement but required repeat thoracotomy, lung decortication, and mechanical pleurodesis in the setting of a moderate-sized right multiloculated empyema. Upon discharge, the patient continued to experience progressive dysphagia and coughing. Speech pathology evaluation did not show aspiration, but a limited esophagram identified a cervical esophageal diverticulum. Because of recurrent fevers, a CT chest film was obtained, which showed a posterior mediastinal abscess (Fig. 2). Abscess drainage revealed polymicrobial growth, raising suspicion of an EMF. Repeat esophagram demonstrated contrast pooling within the diverticulum and extravasation into the