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Normal chest X-ray should not mislead.

Zouheir Ibrahim Bitar1, Mohammed Ibrahim, Hesham Sabry el-Emam

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Lung ultrasound (US) is a valuable tool for intensive care units. In a case of esophageal perforation, bedside lung US accurately detected pneumothorax and pleural effusion missed by chest X-ray, leading to early treatment and a good outcome.

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Area of Science:

  • Critical Care Medicine
  • Diagnostic Imaging
  • Thoracic Surgery

Background:

  • Esophageal perforations are rare but life-threatening emergencies with high mortality rates.
  • Delayed diagnosis of esophageal perforation is common due to non-specific symptoms.
  • Lung ultrasound (LUS) is an accessible bedside tool for intensive care unit (ICU) physicians.

Observation:

  • A 70-year-old woman presented with a suspected postoesophagoscopy esophageal perforation.
  • Postoperative chest X-ray failed to identify pneumothorax and pleural effusion.
  • Bedside lung ultrasound (LUS) immediately detected pneumothorax and mild pleural effusion.

Findings:

  • Lung ultrasound (LUS) provided accurate and timely diagnostic information.
  • Early detection of esophageal perforation via LUS facilitated prompt intervention.
  • The patient experienced a favorable outcome due to early diagnosis and treatment.

Implications:

  • Lung ultrasound (LUS) can be a crucial diagnostic modality in suspected esophageal perforations.
  • This case highlights the utility of LUS in identifying thoracic complications missed by conventional radiography.
  • Integrating LUS into the diagnostic pathway may improve patient outcomes for esophageal perforations.