Esophageal disruption: evaluation with iohexol esophagography

Area of Science:

• Radiology
• Gastroenterology
• Medical Imaging

Background:

• Esophageal disruption diagnosis requires imaging, but traditional barium studies carry risks like mediastinitis.
• Patients at risk for aspiration or tracheobronchial communication need specialized imaging techniques.
• Water-soluble contrast agents offer an alternative, but their efficacy in specific esophageal conditions needs evaluation.

Purpose of the Study:

• To evaluate the diagnostic utility and safety of iohexol esophagography in patients with suspected esophageal disruption.
• To compare the findings of iohexol esophagography with barium esophagography in a high-risk patient cohort.

Main Methods:

• Twenty-six patients with suspected esophageal disruption and aspiration risk underwent iohexol esophagography.
• Fifteen patients subsequently had barium esophagography for comparison.
• Abnormal findings from iohexol studies were analyzed, and a subset underwent repeat barium studies.

Main Results:

• Iohexol esophagography identified abnormalities in 11 patients, including extravasation (n=7), aspiration (n=1), stricture (n=1), edema (n=1), and diverticulum (n=1).
• Fifteen studies were normal, confirmed by subsequent barium examinations.
• Repeat barium esophagography in eight patients with abnormal iohexol findings provided no additional diagnostic information.

Conclusions:

• Low-osmolality, water-soluble contrast agents like iohexol are safe and effective for evaluating esophageal disruption.
• Iohexol esophagography is a valuable alternative when barium contrast poses a risk of mediastinitis.
• It offers a safer option than diatrizoate meglumine/diatrizoate sodium (Gastrografin) for patients at risk of pulmonary edema.