Bacterial infection can occur within the mediastinum as a result of oesophageal perforation. This can cause inflammation of the connective tissues and fat in the mediastinal space. What is this pathology called?
The pathology is called acute mediastinitis and is considered a serious and potentially life-threatening condition.
1. An anomalous path of the nasogastric tube is seen, with a mostly submucosal course from the proximal oesophagus to the distal oesophagus. There is possible oesophageal perforation at two sites:
i. At the level of T1, where the nasogastric tube likely enters the submucosal layer beyond the mucosal margins of the proximal oesophagus, forming a false lumen.
ii. The nasogastric tube in the submucosal plane/false lumen appears to re-enter the true oesophageal lumen at the distal oesophagus, following the path of the oesophagus into the stomach. However, the actual re-entry point is not confidently identified as the distal oesophagus is collapsed.
There is resultant extensive mediastinal and cervical emphysema, as well as, extensive mediastinitis. No drainable mediastinal collection is seen.
Associated near-complete collapse consolidation of the left lower lobe is likely
due to ongoing pneumonia.
2. No mucosal defect is seen in the stomach to suggest perforation. No definite pneumoperitoneum. Gas anterior to the pancreas in the upper abdomen is deemed intraluminal gas of the duodenal cap.