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Weekly Chest CasesArchive of Old Cases

Case No : 1074 Date 2018-05-29

  • Courtesy of Song Soo Kim, MD. / Chungnam National University College of Medicine
  • Age/Sex 57 / M
  • Chief Complaintchest pain and epigastric pain
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Acute phlegmonous esophagitis
Radiologic Findings
Fig 1. Chest PA shows increased opacity in BLLZ and abnormal bulging of the descending thoracic aorta.
Figs 2-3. Mediastinal window setting of the chest CT scan shows diffuse edematous circumferential wall thickening of the esophagus along with intramural low density lesion. On coronal image, the lesion extends to the gastric cardia.
Brief Review
Acute phlegmonous esophagitis is purulent inflammation of the submucosa and muscular layer of the esophagus, sparing the mucosa. It is a potentially fatal disease with many complications, such as esophageal perforation, mediastinitis, peritonitis, and empyema.
There are many predisposing factors, such as immune suppression, alcoholism, peptic ulcer disease, chronic gastritis or some other gastric mucosal injury, achlorhydria, infection, connective tissue disease, and malignancy.
CT findings of acute phlegmonous esophagitis are diffuse esophageal wall thickening and intramural circumferential low attenuated area of the esophagus, surrounded by peripheral rim enhancement. It is suggestive of abscess in the submucosa and muscularis layer of the esophagus. Some cases present with air bubbles within the thickened wall, due to gas-forming pathogens.
References
1. J Korean Med Sci 2010; 25: 1532-1535. Acute Diffuse Phlegmonous Esophagogastritis: A Case Report.
2. Am J Case Rep, 2017; 18: 125-130. A Rare Case of Acute Phlegmonous Esophagogastritis Complicated With Hypopharyngeal Abscess and Esophageal Perforation.
Keywords
Esophagus, Non-infectious inflammation,

No. of Applicants : 104

▶ Correct Answer : 38/104,  36.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - IRSA LA ROCHEELLE , France JEAN LUC BIGOT
  • - Ajou University Hospital , Korea (South) PAE SUN SUH
  • - MD , India DEEPANDER SINGH RATHORE
  • - Other , Korea (South) SEONGSU KANG
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - , Korea (South) HYO JAE LEE
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - NTUH , Taiwan KUEI-PIN CHUNG
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Other , Korea (South) JIN YOUNG KIM
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - TB centre kasaragod. , India rikhy krishnan
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Korea (South) SEOYOUNG PARK
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Al Buraimi Medical Center , Oman WESAM ADEL NASSER
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Chonnam National University Hospital , Korea (South) YU BIN LEE
▶ Correct Answer as Differential Diagnosis : 11/104,  10.6%
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - , Japan YUMI MAEHARA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
▶ Semi-Correct Answer : 32/104,  30.8%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - dayanand , India REENA GUPTA
  • - Niigata University , Japan ATSUSHI UEHARA
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Ondokuz mayis University , Turkey Tumay Bekci
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - HHS , Canada S LEE
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - Ewha Womans University Medical Center , Korea (South) YOUNGSUN KO
  • - , Viet Nam HUNG MANH LE
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - eskisehir devlet hastanesi , Turkey MURAT SAHIN
  • - , Algeria NABIL BOUHAFARA
  • - , Japan NAOMI YUASA
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Lilavati Hospital , India DHRUV UMESH SHARMA
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
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