Abstract
A man in his 60s was ultimately diagnosed with a secondary lung abscess caused by an esophagorespiratory fistula. On admission, however, he had initially been diagnosed with a primary lung abscess because of aspiration, given his history of alcohol use. Secondary lung abscesses can result from various underlying conditions. Among these, esophagorespiratory fistulas are significant causes and are often associated with esophageal cancers. An intriguing aspect of this case is that secondary lung abscesses originating from esophageal cancer can occur under similar conditions as aspiration-related pulmonary suppuration. Given the difficulty in distinguishing between the two based solely on imaging, physicians should exercise caution when encountering patients with a history of heavy alcohol consumption.