A 54-Year-Old Male With Persistent Air Leak After Endotracheal Intubation.

Tracheoesophageal fistulas (TEFs) are abnormal communications between the trachea and oesophagus that may be congenital or acquired. Clinical presentation can be subtle and nonspecific. We report a case of a 54-year-old male with advanced HIV, end-stage renal disease and multiple comorbidities who developed a persistent air leak after emergent intubation following cardiac arrest. Despite endotracheal tube exchange, the air leak persisted and was accompanied by marked abdominal distension. Computed tomography (CT) imaging revealed a tracheal defect near the left mainstem bronchus and bronchoscopy confirmed a TEF. The patient underwent oesophageal stent placement; however, methylene blue testing demonstrated a persistent communication between the oesophagus and airway. Given his poor overall prognosis, the family opted to withdraw life-sustaining treatment. This case highlights the importance of considering TEF in mechanically ventilated patients with persistent air leak unresponsive to tube exchange.