Presentation
Recurrent aspiration after esophagectomy.
Patient Data
There has been a previous esophagectomy and gastric pull through, forming a neo-esophagus.
Following the administration of oral gastrografin contrast, there is contrast extravasation into the soft tissues behind the neo-esophagus consistent with an esophageal leak.
Additionally, there are inflammatory changes in the right basal area extending towards the posterior mediastinum behind the neo-esophagus, consistent with secondary mediastinitis and right lower lobe collapse.
Case Discussion
Key learning points:
CT with oral contrast can reveal contrast extravasation, indicating the presence of an esophageal defect, such as a leak or a fistulation tract 1
Gastrografin is normally avoided if there is a history of aspiration due to the risk of pulmonary edema
Soft tissue changes are common around the esophageal defect, reflecting secondary inflammation and infection 2
The most common cause of an esophageal defect is iatrogenic, from endoscopic procedures such as balloon dilation 3
Patients who have undergone esophageal surgery may develop esophageal defects as a late complication, commonly occurring at the anastomotic site where blood supply is poor 4
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