Iatrogenic esophageal perforation with esophageal-pleural fistula-CT esophagography

Case contributed by Dr Mohamed Saber

Presentation

Distal esophageal stricture, subjected to endoscopic dilatation followed by severe chest pain and dyspnea for two days

Patient Data

Age: 35 years
Gender: Male

CT study shows the following:

  • mural thickening of the distal esophagus with contrast leak within the pleural spaces bilaterally indicating iatrogenic esophageal perforation with esophageal-pleural fistula
  • bilateral chest tubes with residual (hydro/pyo-pneumothorax) associated with compression atelectasis of the lung bases.
  • moderate dilatation of the esophagus matching with the patient’s known history of distal stricture
  • the contrast is seen reaching the stomach and opacifying its lumen

Case Discussion

Here is a case of esophageal perforation with esophageal pleural fistula post endoscopy. Instrumentation and thoracic surgery are the most common causes of esophageal perforation.

In this case, fluoroscopy was not available, so we used CT esophagography instead with very good diagnostic results

CT esophagography is a CT study designed to primarily evaluate the esophagus, particularly in the situation of esophageal trauma and potential perforation. It has been developed partly as an alternative to fluoroscopic barium swallow evaluation in this situation.

As the patient general condition was bad, he was unable to drink the oral contrast so a nasogastric tube was placed with an injection of the diluted water-soluble oral contrast through

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Case information

rID: 88965
Published: 25th Apr 2021
Last edited: 26th Apr 2021
Inclusion in quiz mode: Included
Institution: Faculty of medicine Al-Azhar University

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