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Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study

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Abstract

Purpose

Esophageal perforation has a high mortality rate. Fluoroscopic esophagography (FE) is the procedure of choice for diagnosing esophageal perforation. However, FE can be difficult to perform in seriously ill patients.

Methods

We retrospectively reviewed charts and scans of all patients who had undergone thoracic CT (TCT) without oral contrast and FE for suspicion of esophageal perforation at our hospital between October, 2010 and December, 2015. Scans were interpreted by a single consultant radiologist having > 5 years of relevant experience. Statistical analysis was performed using SPSS version 20. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TCT were computed using FE as reference standard.

Results

Of 122 subjects, 106 (83%) were male and their median age was 42 [inter-quartile range (IQR) 29–53] years. Esophageal perforation was evident on FE in 15 (8%) cases. Sensitivity, specificity, PPV and NPV of TCT for detecting esophageal perforation were 100, 54.6, 23.4 and 100%, respectively. When TCT was negative (n = 107), an alternative diagnosis was evident in 65 cases.

Conclusion

Thoracic computed tomography (TCT) had 100% sensitivity and negative predictive value for excluding esophageal perforation. FE may be omitted in patients who have no evidence of mediastinal collection, pneumomediastinum or esophageal wall defect on TCT. However, in the presence of any of these features, FE is still necessary to confirm or exclude the presence of an esophageal perforation.

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References

  1. Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77:1475–83.

    Article  PubMed  Google Scholar 

  2. Søreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011;19:66.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Vogel SB, Rout WR, Martin TD, Abbitt PL. Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg. 2005;241:1016–23.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bhatia P, Fortin D, Inculet RI, Malthaner RA. Current concepts in the management of esophageal perforations: a twenty-seven year Canadian experience. Ann Thorac Surg. 2011;92:209–15.

    Article  PubMed  Google Scholar 

  5. Wu JT, Mattox KL, Wall MJ Jr. Esophageal perforations: new perspectives and treatment paradigms. J Trauma Acute Care Surg. 2007;63:1173–84.

    Article  Google Scholar 

  6. Kiernan PD, Sheridan MJ, Elster E, Rhee J, Collazo L, Byrne WD, et al. Thoracic esophageal perforations. South Med J. 2003;96:158–63.

    Article  PubMed  Google Scholar 

  7. Vial CM, Whyte RI. Boerhaave’s syndrome: diagnosis and treatment. Surg Clin North Am. 2005;85:515–24.

    Article  PubMed  Google Scholar 

  8. Fadoo F, Ruiz DE, Dawn SK, Webb WR, Gotway MB. Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture. AJR Am J Roentgenol. 2004;182:1177–9.

    Article  PubMed  Google Scholar 

  9. Traub M, Stevenson M, McEvoy S, Briggs G, Lo SK, Leibman S, et al. The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury. 2007;38:43–7.

    Article  PubMed  Google Scholar 

  10. Hanpeter DE, Demetriades D, Asensio JA, Berne TV, Velmahos G, Murray J. Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. J Trauma Acute Care Surg. 2000;49:689–95.

    Article  CAS  Google Scholar 

  11. Ghanem N, Altehoefer C, Springer O, Furtwängler A, Kotter E, Schäfer O, et al. Radiological findings in Boerhaave’s syndrome. Emerg Radiol. 2003;10:8–13.

    PubMed  Google Scholar 

  12. di Castelguidone ED, Merola S, Pinto A, Raissaki M, Gagliardi N, Romano L. Esophageal injuries: spectrum of multidetector row CT findings. Eur J Radiol. 2006;59:344–8.

    Article  Google Scholar 

  13. Akobeng AK. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr. 2007;96:644–7.

    Article  PubMed  Google Scholar 

  14. Wu CH, Chen CM, Chen CC, Wong YC, Wang CJ, Lo WC, et al. Esophagography after pneumomediastinum without CT findings of esophageal perforation: is it necessary? AJR Am J Roentgenol. 2013;201:977–84.

    Article  PubMed  Google Scholar 

  15. Borraez B, Patti MG. Radiologic evaluation of esophageal diseases. In: Fisichella PM, Patti MG, editors. Atlas of esophageal surgery. Switzerland: Springer International Publishing AG; 2015. pp. 9–21.

    Chapter  Google Scholar 

  16. Young CA, Menias CO, Bhalla S, Prasad SR. CT features of esophageal emergencies. RadioGraphics. 2008;28:1541–53.

    Article  PubMed  Google Scholar 

  17. Pinto A, Liguori C, Cinque T, Gagliardi N, Romano L. Esophageal Injuries. In: Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S, editors. Emergency radiology of the chest and cardiovascular system. Switzerland: Springer International Publishing AG; 2017. pp. 73–8.

    Google Scholar 

  18. Shanmuganathan K, Matsumoto J. Imaging of penetrating chest trauma. Radiol Clin N Am. 2006;44:225–38.

    Article  PubMed  Google Scholar 

  19. Karmy-Jones R, Wood DE. Traumatic injury to the trachea and bronchus. Thorac Surg Clin. 2007;17:35–46.

    Article  PubMed  Google Scholar 

  20. Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging. 2011;2:281–95.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Swanson JO, Levine MS, Redfern RO, Rubesin SE. Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. AJR Am J Roentgenol. 2003;181:415–20.

    Article  PubMed  Google Scholar 

  22. Makhani M, Midani D, Goldberg A, Friedenberg FK. Pathogenesis and outcomes of traumatic injuries of the esophagus. Dis Esophagus. 2014;27:630–6.

    Article  CAS  PubMed  Google Scholar 

  23. Khan AZ, Strauss D, Mason RC. Boerhaave’s syndrome: diagnosis and surgical management. Surgeon. 2007;5:39–44.

    Article  CAS  PubMed  Google Scholar 

  24. Gaudinez RF, English GM, Gebhard JS, Brugman JL, Donaldson DH, Brown CW. Esophageal perforations after anterior cervical surgery. Clin Spine Surg. 2000;13:77–84.

    CAS  Google Scholar 

  25. Zhang L, Yang Y, Zhang J, Zhou X, Dong H, Zhou Y. Barium sulfate aspiration: severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema. Forensic Sci Int. 2015;253:e16–e9.

    Article  CAS  PubMed  Google Scholar 

  26. Jat AA, Khan MR, Zafar H, Raja AJ, Hoda Q, Rehmani R, et al. Peer review audit of trauma deaths in a developing country. Asian J Surg. 2004;27:58–64.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan

    Muhammad Awais, Saqib Qamar, Abdul Rehman, Noor Ul-Ain Baloch & Gulnaz Shafqat

  2. Department of Radiology, Dow University of Health Sciences, Ojha Campus, Suparco Road, KDA Scheme 33, Karachi, Sindh, 75270, Pakistan

    Muhammad Awais

  3. Internal Medicine Section, Department of Medicine, Hamad Medical Corporation, P.O. box 3050, Doha, Qatar

    Abdul Rehman

  4. Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA

    Noor Ul-Ain Baloch

Authors
  1. Muhammad Awais
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  2. Saqib Qamar
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  3. Abdul Rehman
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  4. Noor Ul-Ain Baloch
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  5. Gulnaz Shafqat
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Corresponding author

Correspondence to Muhammad Awais.

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Conflict of interest

Muhammad Awais, Saqib Qamar, Abdul Rehman, Noor Ul-Ain Baloch and Gulnaz Shafqat have no conflict of interests to disclose.

Ethical standards

All procedures related to this study were performed in accordance with ethical standards of the institutional ethics review committee and with the most recent version of the Declaration of Helsinki (1964).

Informed consent

As this was a retrospective study, formal consent was not required and requirement of informed consent was waived.

Additional information

This study was presented as a Scientific Exhibit at the European Congress of Radiology (ECR) 2016 held at Vienna, Austria.

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Awais, M., Qamar, S., Rehman, A. et al. Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study. Eur J Trauma Emerg Surg 45, 517–525 (2019). https://doi.org/10.1007/s00068-018-0929-4

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  • DOI: https://doi.org/10.1007/s00068-018-0929-4

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