American Journal of Roentgenology, Vol 160, 767-770, Copyright © 1993 by American Roentgen Ray Society

ARTICLES

Esophageal perforation: CT findings

CS White, PA Templeton and S Attar
Department of Radiology, University of Maryland Medical Center, Baltimore 21201.

OBJECTIVE: Esophageal perforation is a life-threatening condition that can be quickly diagnosed on the basis of findings on contrast esophagograms when the typical signs and symptoms of vomiting, chest pain, and subcutaneous emphysema occur. If the clinical features are atypical, CT may be performed early in the clinical course. Thus, recognition of the CT findings of esophageal perforation is important. MATERIALS AND METHODS: We reviewed the CT scans of 12 patients with esophageal perforation. The site of perforation was the cervical esophagus in three and the thoracic esophagus in nine. The causes of the perforations were neoplastic (four patients), idiopathic (three patients), iatrogenic (three patients), and traumatic (two patients). RESULTS: CT abnormalities included esophageal thickening in nine patients, periesophageal fluid in 11 patients, extraluminal air in 11, and pleural effusion in nine. The site of the perforation was visible on the CT scan in two patients. In four patients (33%), CT findings were the first indication of esophageal perforation. CONCLUSION: For patients who have atypical signs and symptoms, CT scans optimally define the extraluminal manifestations of esophageal perforation. Extraesophageal air is the most useful finding. The CT findings may be the first indication of the diagnosis.
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