58-year-old male with metastatic esophageal cancer and persistent pleural effusions, question esophageal fistula. CHEST:LUNGS AND PLEURA: Interval decrease in size of a small non-loculated left effusion with persistent left basilar consolidation/atelectasis. Left chest tube tip terminates near the left apex within the effusion. Minimal amount of pleural air adjacent to chest tube. Highattenuating pleural fluid dependently on left, possible hemorrhage. Small right effusion persists with interval decrease in consolidation/atelectasis in the right base. Multiple scattered focal ground glass lesions in the periphery of the right lung, likely atelectasis/aspiration.MEDIASTINUM AND HILA: Interval placement of additional esophageal stents with fluid within the stents. Stents now extending from just below the thoracic inlet to the gastric body. No definite evidence of esophageal fistula. Tracheostomy tube tip with adjacent fluid within the trachea. Extensive coronary artery calcifications.CHEST WALL: Left chest port with tip in the SVC. ABDOMEN: Solid organ evaluation is limited by lack of intravenous contrast.LIVER, BILIARY TRACT: Gallbladder is prominent.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst, similar to prior.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate/severe degeneration of the lumbar spine. L5/S1 laminectomy.OTHER: No significant abnormality noted.
1) Left chest tube tip directed toward the left apex with a now small, non-loculated left pleural effusion with small amount of pleural hemorrhage. Left basilar atelectasis/consolidation persists.2) Persistent right small effusion with decreased basilar consolidation.3) Esophageal stents extend from just below the thoracic inlet to the gastric body.