CT Esophagography for Evaluation of Esophageal Perforation. Radiographics 2021;41(2):447-461
Date
02/13/2021Pubmed ID
33577418DOI
10.1148/rg.2021200132Scopus ID
2-s2.0-85102538367 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
Esophageal emergencies such as rupture or postoperative leak are uncommon but may be life threatening when they occur. Delay in their diagnosis and treatment may significantly increase morbidity and mortality. Causes of esophageal injury include iatrogenic (including esophagogastroduodenoscopy and stent placement), foreign body ingestion, blunt or penetrating trauma to the chest or abdomen, and forceful retching, also called Boerhaave syndrome. Although fluoroscopic esophagography remains the imaging study of choice according the American College of Radiology appropriateness criteria, CT esophagography has been shown to be at least equal to if not superior to fluoroscopic evaluation for esophageal injury. In addition, CT esophagography allows diagnosis of extraesophageal abnormalities, both as the cause of the patient's symptoms as well as incidental findings. CT esophagography also allows rapid diagnosis since the examination can be readily performed in most clinical settings and requires no direct radiologist supervision, requiring only properly trained technologists and a CT scanner. Multiple prior studies have shown the limited utility of fluoroscopic esophagography after a negative chest CT scan and the increase in accuracy after adding oral contrast agent to CT examinations, although there is considerable variability of CT esophagography protocols among institutions. Development of a CT esophagography program, utilizing a well-defined protocol with input from staff from the radiology, gastroenterology, emergency, and general surgery departments, can facilitate more rapid diagnosis and patient care, especially in overnight and emergency settings. The purpose of this article is to familiarize radiologists with CT esophagography techniques and imaging findings of emergent esophageal conditions. Online supplemental material is available for this article. ©RSNA, 2021.
Author List
Norton-Gregory AA, Kulkarni NM, O'Connor SD, Budovec JJ, Zorn AP, Desouches SLAuthors
Joseph J. Budovec MD Professor in the Radiology department at Medical College of WisconsinStephane Desouches DO Vice Chair, Associate Professor in the Radiology department at Medical College of Wisconsin
Naveen Kulkarni MD Assistant Professor in the Radiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Contrast MediaEsophageal Perforation
Humans
Sensitivity and Specificity
Tomography, X-Ray Computed
