Purpose or Case Report: An 11-day-old male presented with recurrent choking episodes. Chest radiograph demonstrated partial opacification of the right hemithorax with associated air- bronchograms. Due to concern for tracheoesophageal fistula, a single-contrast barium esophagram was performed and demonstrated an anomalous bronchus arising from the distal esophagus. Subsequent CT of the chest showed an esophageal bronchus arising from the gastroesophageal junction with branches extending to the right lower and right upper lobes. No additional intrathoracic anomaly was identified. The patient was then treated with right upper lobectomy, right lower lobe apical segmentectomy and resection of the esophageal bronchus.

The esophageal bronchus is a rare communicating bronchopulmonary foregut malformation in which a bronchus arises from the esophagus. This anomalous bronchus may supply an entire lung or a single lobe. Although the lung parenchyma associated with the aberrant bronchus is classically supplied by the pulmonary circulation (thereby distinguishing it from a sequestration), additional anomalies are often seen. A few of the more frequently observed associated anomalies include pulmonary artery anomalies, esophageal atresia, duodenal atresia and tracheoesophageal fistula.

Diagnosing an esophageal bronchus begins with chest radiography, which will demonstrate a pattern of airspace disease that resembles a lobar pneumonia. This pattern of opacification is atypical in the neonatal setting, where the vast majority of pulmonary diseases, including pneumonia and aspiration, typically manifest as diffuse and bilateral processes. As patients with an esophageal bronchus also present with feeding difficulties, obtaining an esophagram is the next step in making the diagnosis. The esophagram will demonstrate filling of an abnormal structure that is often seen to be directed cranially and, with continued opacification, may be observed as a branching structure overlying opacified lung. Finally, cross-sectional imaging can be obtained to delineate the vasculature associated with the esophageal bronchus and to assess for additional anomalies.

The most common treatment of an esophageal bronchus is lobectomy. However, when the associated lung parenchyma is normal, performing an anastomosis between the esophageal bronchus and the tracheobronchial tree has been reported. On the contrary, pneumonectomy may be required in cases where anomalous vascularity precludes lobectomy.
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