2), which both revealed significant increase of the inflammatory infiltrates, with expansion of the bronchopneumonia in both the Epigenetics inhibitor middle and lower right lobes, as well as accumulation of small amount of pleuritic fluid. Antibiotic treatment changed from amoxicillin-clavulanic acid to piperacillin-tazobactam, in order to cover possible hospital-acquired pathogens, but the patient remained feblile. Simultaneously, the patient reported new onset, worsening cough, and, particularly, bouts of cough when swallowing liquids. This new symptom raised clinical suspicion of a communication between the respiratory tree and the upper gastrointestinal tract. The patient was advised to stop eating, and was subjected to a barium-oesophagography,

which confirmed the presence of a BOF (Fig. 3). The patient was referred to a specialized department of Cardio-Thoracic Surgery, where open right thoracotomy and resection of the fistulous tract, along with right middle lobectomy, were performed. The fistula was about 3 cm long, connecting the

right middle segmental bronchus and the lower third of the oesophagus, while the right middle lobe macroscopically resembled liver parenchyma. The histopathological examination reported that the whole lobe removed was atelectatic with evidence of chronic pneumonitis, while medium-sized bronchi were moderately dilated and full of cellular debris. The fistula was covered with squamous epithelial tissue. No evidence of malignancy or granuloma formation was found in the samples taken from the reactively hyperplastic hilar lymph nodes. Post-operative course of the patient

2-hydroxyphytanoyl-CoA lyase was excellent and the patient was discharged 8 days later. Congenital communications ABT-888 research buy between the respiratory tree and the oesophagus are rare developmental anomalies (1:3000 to 1:4500 live births) resulting from failure of the lung bud to separate completely from the foregut, a procedure that takes place between the 4th and the 6th weeks of gestation.4 In the majority of cases, this malformation is accompanied by oesophageal atresia, and is typically presented in infancy.1, 2, 3 and 4 However, in the so-called “H-type” fistula, which comprises only 3–6% of all cases, the oesophagus is otherwise normal, communicating with either the trachea or a bronchus, formulating either a TOF or a BOF, respectively.1 and 2 Congenital BOFs were first described by Negus in 19292 and 5 and were classified into four categories by Braimbridge and Keith in 1965.3 So far, only about 100 cases have been reported in the literature.1 Their presentation may be delayed until childhood or adult life, with a median age of 33 years old, while the duration of symptoms can vary from 6 months to 50 years, with a mean of 17 years.1 and 2 No sex predominance has been described.1 and 2 The majority (90%) of fistulas are type II according to Braimbridge classification.5 The communication is usually short and is running directly from the oesophagus to a main or segmental bronchus.