CASE 563 Published on 06.11.2000

Combined blunt tracheal and esophageal ruptures

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Patient

44 years, male

Categories

No Area of Interest ; Imaging Technique CT

No Procedure ; No Special Focus ;

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Clinical History

Traffic accident

Imaging Findings

44-year-old male car driver involved in a high-speed deceleration crash

Discussion

Blunt esophageal lesions are encountered in less than 0.01% of cases. They occur in violent traffic accidents, as part of a crushing mechanism, and are associated with a 57% mortality, consecutive to associated lesions or to delayed mediastinitis and subsequent sepsis. Esophageal injuries include mucosal dissections, intramural hematomas, lacerations and ruptures. They are often associated with other visceral lesions, such as tracheo-bronchial ones, due to the mechanism and severity of trauma.

Differential Diagnosis List

Combined blunt tracheal and esophageal ruptures at the cervical level, with subsequent cervical emphysema

Final Diagnosis

Combined blunt tracheal and esophageal ruptures at the cervical level, with subsequent cervical emphysema

References

[1] Beal SL, Pottmeyer EW, Spisso JM.
Esophageal perforation following external blunt trauma.
J Trauma 1988;28: 1425-1432. (PMID: 3172300)

[2] Bladergroen MR, Lowe JE, Postlethwait RW.
Diagnosis and recommended management of esophageal perforation and rupture.
Ann Thorac Surg 1986;42: 235-239. (PMID: 3753071)

[3] Ghahremani GG.
Esophageal trauma.
Semin Roentgenol 1994;29: 387-400. (PMID: 7809652)

[4] White RK, Morris DM.
Diagnosis and management of esophageal perforations.
Am Surg 1992;58: 112-119. (PMID: 1550302)

[5] Wintermark M, Wicky S, Bettex D, et al. Trauma of the mediastinum. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 71-134 (2000).

Case information

URL:	https://eurorad.org/case/563
DOI:	10.1594/EURORAD/CASE.563
ISSN:	1563-4086

Figure 1

Combined blunt tracheal and esophageal ruptures at the cervical level, with subsequent cervical emphysema

Air bubble in cervical subcutaneous tissues - Coned-view of the admission plain film displays a cervical round air collection (arrows) leftwards located with respect to the trachea (From Wintermark M, Wicky S, Bettex D, et al (2000) Trauma of the mediastinum. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 71-134)

Spiral CT section (3-mm) depicts a large gap in the left antero-lateral tracheal wall (white arrow). This gap is occluded by the endotracheal tube balloon cuff . A hypodensity (black arrows) located on the right side of the esophagus (made visible by an opaque naso-gastric tube) was identified as a possible soft tissue air collection and raised suspicion about an esophageal tear. The latter was demonstrated during esophagoscopy and surgery (From Wintermark M, Wicky S, Bettex D, et al (2000) Trauma of the mediastinum. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 71-134).