esophageal rupture christine young, ms4 paul lewis, md
TRANSCRIPT
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Esophageal rupture
Christine Young, MS4
Paul Lewis, MD
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• CC: Substernal and Epigastric pain
• HPI: Pt is a 80 yo M with PMH of HTN, COPD, OSA and hx of recurrent GI bleeding who presents as a transfer from OSH with concern for esophageal rupture s/p enteroscopy for recurrent small bowel AVM bleeding.
Post-procedure, pt developed increased SOB and severe epigastric/substernal chest pain with radiation to back. CT chest showed evidence of esophageal rupture at level of carina, and pt transferred to RUMC for emergent intervention.
• VS: HR 103 BP: 163/74 T: 101.1 RR: 34 SpO2: 93 % on 5L NC
• Exam: Chest – Hamman’s sign (anterior mediastinal crunch), fair air movement. Abdomen-epigastric tenderness to palpation.
Patient presentation
2
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1. CXR– Upright PA and lateral chest.– diagnostic in 90% of cases of esophageal rupture.
2. CT chest without contrast– Air in the mediastinum surrounding esophagus is the most
diagnostic finding of esophageal rupture.
3. Barium swallow (fluoroesophagram)– Barium esophagram following plain radiography may be
performed to look for extravasation of contrast and location and extent of rupture/tear.
Diagnostic Imaging Options:
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CT chest without IV
MRN: 6545709
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CT chest with contrast
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Coronal view CT
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Fluoroesophagram
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Fluoroesophagram
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Fluoroesophagram
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Fluoroesophagram
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Fluoroesophagram
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Fluoroesophagram
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Surgical findings:
Cardiothoracic surgery placed esophageal stent via right lateral approach that resulted in partial lung resection (R lower lobe).
Operative report:– 1 cm esophageal perforation from 33 to
34 cm from incisors.– Adhesions and calcified pleural plaques
from asbestos exposure.
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CXR
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Fluoroesophagram
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Fluoroesophagram
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Clinical status/follow up
Esophageal stent evaluated post-op with fluoroesophagram that was negative for esophageal leak.
Patient’s post-op course included a prolonged hospital stay due to other medical issues (v-tach episode that self-
corrected, received cardiac work-up to determine etiology).