Acquiring the Diagnosis of an Acquired Tracheoesophageal Fistula with EtCO2: A Case Discussion with Review of the Literature.

Acquired tracheoesophageal fistula (TEF) is a rare complication of esophageal or lung cancer. A 57-year-old male presented with complaints of vomiting, cough, 20 lb weight loss, and progressive dysphagia. Early laryngoscopy and CT chest showed a normal pharynx with an irregular thickness of the thoracic esophagus. The upper gastrointestinal endoscopy (UGIE) and upper endoscopic ultrasound (EUS) revealed a hypoechoic mass evolving as complete obstruction. During the procedure, minimal CO2 was used for insufflation; however, when attempts were made to traverse the obstruction, capnography revealed an end-tidal CO2 (EtCO2) estimating 90 mmHg indicating possible TEF. This case depicts the use of capnography during UGIE in diagnosing an acquired TEF.

Case of Cocaine Induced Coronary and Carotid Artery Dissection.

Cocaine use has been individually linked to both carotid and coronary artery dissections. However, their simultaneous occurrence has not been previously reported. A 30-year-old man who suffered an acute ischemic stroke and myocardial infarction secondary to acute carotid and coronary artery dissections, respectively, 16 hours after snorting cocaine. To our knowledge, this is the first reported case describing the simultaneous occurrence of carotid and coronary artery dissections resulting from cocaine use.