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Delayed presentation of oesophageal perforation simulating intrathoracic malignancy
P A Set1, C D Flower, S Stewart
1Department of Diagnostic Radiology, Papworth Hospital, Cambs.
Clinical Radiology
|November 1, 1992
Summary
Silent esophageal perforation is often missed preoperatively. Computed tomography scans revealed a similar soft tissue mass and vertebral body destruction in both patients, highlighting diagnostic challenges.
Area of Science:
- Gastroenterology
- Radiology
- Thoracic Surgery
Background:
- Esophageal perforation is a serious condition requiring prompt diagnosis and treatment.
- Silent perforations, where symptoms are minimal or absent, pose significant diagnostic challenges.
Observation:
- Two patients presented with undiagnosed silent esophageal perforations.
- Referring physicians failed to diagnose the condition preoperatively in both cases.
- A history of dysphagia (swallowing difficulty) was present in only one patient.
Findings:
- Computed tomography (CT) scans demonstrated a consistent pattern in both patients.
- A soft tissue mass in the upper retro-esophageal region was observed.
- Destruction of the adjacent vertebral body was noted on CT imaging.
Implications:
- This case series underscores the importance of considering silent esophageal perforation in patients with unexplained retro-esophageal masses.
- Radiological findings, particularly vertebral body involvement, may be crucial in suspecting this diagnosis.
- Improved preoperative recognition of silent esophageal perforation could lead to earlier intervention and potentially better patient outcomes.