Adult presentation of congenital tracheooesophageal fistula treated as asthma and recurrent respiratory infections

The patient had been diagnosed with asthma when he was a child; he had previously needed a hospital admission which required him to be intubated, due to an exacerbation of his illness. On examination, the patient was initially tachypnoeic on bilevel positive airway pressure with increased respiratory effort and oxygen saturation of 89%; his lungs were clear on auscultation bilaterally with minimal wheezing heard. Additionally, he had none of the other clinical features of either VACTERL association—specifically vertebral defects, anal atresia, cardiac defects, renal anomalies, and limb abnormalities—or CHARGE syndrome—specifically coloboma, cranial nerve abnormalities, choanal atresia, and so-called CHARGE ear (middle and inner ear abnormalities, which can contribute to hearing problems, and atypically shaped external ears).