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Computed tomography in patients with esophageal perforation
C L Backer1, J LoCicero, R S Hartz
1Department of Surgery, Northwestern University Medical School, Chicago.
Chest
|November 1, 1990
Summary
Contrast esophagram is the diagnostic procedure of choice for suspected esophageal perforation. However, computed tomography (CT) of the chest can reveal mediastinal fluid and air, suggesting perforation when diagnosis is obscure.
Area of Science:
- Gastroenterology
- Radiology
- Thoracic Surgery
Background:
- Esophageal perforation diagnosis relies on contrast esophagram.
- Subtle or unrecognized symptoms can obscure diagnosis.
- Computed tomography (CT) may aid diagnosis in challenging cases.
Observation:
- Three patients with esophageal perforations (spontaneous, carcinoma erosion, iatrogenic) were reviewed.
- Initial diagnosis was missed or delayed in two patients.
- One patient's initial esophagram was normal.
Findings:
- Mediastinal fluid and air on chest CT suggested esophageal perforation.
- CT findings were crucial for diagnosis when clinical signs were absent or misleading.
- Prompt surgical intervention followed CT diagnosis.
Implications:
- CT of the chest is a valuable tool for diagnosing esophageal perforation, especially in obscure cases.
- Identifying mediastinal air on CT is a strong indicator of esophageal injury.
- Early CT diagnosis facilitates timely surgical management and improves patient outcomes.