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Tracheoesophageal fistula (TEF) is uncommon in adults, and it is mostly associated with cancer, trauma and iatrogenic processes. Because there is a communication between the oesophagus and the bronchial tree, TEF is a risk factor for pulmonary infectious, owing to facilitating aspirations from digestive system, as well as, by passage of food. Thus, there is “failure” of the mechanical defending barrier of the respiratory system to prevent pulmonary infection disease. In this context, we present a case of an elderly man who was admitted to the Emergency Service with dyspnoea, fever, productive cough and weight loss, whom primary diagnosis was pneumonia and after a further study it was associated with a TEF by achalasia.
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