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Instrumental esophageal perforation: chest film findings
L Panzini1, M I Burrell, M Traube
1Gastroenterology Unit, Yale University School of Medicine, New Haven, Connecticut.
Abstract:
The aim of this study was to evaluate plain film findings of the chest in instrumental esophageal perforation. We hypothesized that such "clean" perforations, often detected early, would be associated with a low frequency of abnormal plain film findings. Fifteen patients with instrumental esophageal perforation were identified, and their records and radiographs were reviewed. Twelve (80%) of the patients had abnormalities suggestive of perforation. The most common (60%) abnormality seen was pneumomediastinum. The second most common (33%) finding was a density adjacent to the descending aorta in the left cardiophrenic angle, resulting in loss of contour of the descending aorta at the level of the left diaphragm. We concluded that plain films, even when taken shortly after instrumentation, provide useful information regarding the presence of esophageal perforation.
Insights
Chest X-rays can detect instrumental esophageal perforations early. Most patients (80%) showed abnormalities like pneumomediastinum on plain films, aiding diagnosis.
Area of Science:
- Radiology
- Gastroenterology
- Thoracic Surgery
Background:
- Instrumental esophageal perforation is a serious complication.
- Early detection is crucial for patient outcomes.
- Plain chest films are often the initial imaging modality.
Purpose of the Study:
- To evaluate the utility of plain chest film findings in diagnosing instrumental esophageal perforation.
- To determine the frequency and types of abnormalities associated with this condition.
Main Methods:
- Retrospective review of 15 patients with instrumental esophageal perforation.
- Analysis of initial chest radiograph findings.
- Correlation of radiographic findings with the diagnosis.
Main Results:
- Twelve out of fifteen patients (80%) exhibited abnormal chest X-ray findings suggestive of perforation.
- Pneumomediastinum was the most frequent abnormality (60%).
- A density adjacent to the descending aorta, causing loss of its contour, was the second most common finding (33%).
Conclusions:
- Plain chest films are valuable for detecting instrumental esophageal perforation, even when obtained shortly after instrumentation.
- Radiographic abnormalities, particularly pneumomediastinum, are common in these cases.
- Early radiographic assessment can aid in the timely diagnosis and management of esophageal perforation.