Tracheo-esophageal fistulas (TEF) in adults are very rarely congenital in nature and most of the cases are secondary to neoplastic cause. We report a 26-year-old male with TEF that presented with chronic cough. An x-ray carried out for the patient showed upper lobe bronchiectasis and massive esophageal dilatation. There was no evidence of esophageal malignancy, achalasia, or Chagas' disease. There was no history of trauma, infection, or intervention. The CT demonstrated a small TEF, which was not visualized on esophagogram and confirmed by bronchoscopy. Our case demonstrated that idiopathic, or congenital TEF can be presented in adulthood with esophageal dysmotility and bronchiectasis.