Esophageal rupture

Christine Young, MS4

Paul Lewis, MD

• 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

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:

CT chest without IV

MRN: 6545709

CT chest with contrast

Coronal view CT

Fluoroesophagram

Fluoroesophagram

Fluoroesophagram

Fluoroesophagram

Fluoroesophagram

Fluoroesophagram

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.

CXR

Fluoroesophagram

Fluoroesophagram

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).